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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
$742.64 / $2,318.00 / $11,093.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.62 / $758.81 / $1,002.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,140.00 / $5,948.00 / $9,462.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.35 / $922.50 / $1,273.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.04 / $1,028.08 / $1,542.14
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.35 / $881.22 / $1,321.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,868.80 / $1,868.80 / $2,215.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.93 / $1,052.07 / $1,826.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.17 / $967.81 / $1,738.84