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Indiana rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $4,897.79 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $812.83 / $1,445.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $8,317.64 / $10,471.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $912.01 / $1,513.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $812.83 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,380.38 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,023.29 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $954.99 / $1,659.59