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Louisiana rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$762.00 / $1,850.00 / $3,945.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.96 / $1,056.75 / $1,428.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.29 / $5,652.17 / $10,442.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.54 / $1,079.86 / $1,691.10
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $699.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $1,200.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.31 / $1,111.93 / $1,591.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,141.00 / $4,717.00 / $11,696.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.17 / $994.41 / $1,698.60