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Massachusetts rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,758.00 / $2,733.00 / $4,712.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.81 / $909.22 / $1,380.34
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,591.00 / $4,916.00 / $12,850.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.97 / $1,523.46 / $6,294.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$863.79 / $1,419.74 / $2,371.64
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.64 / $1,713.44 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.44 / $1,110.10 / $1,507.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.96 / $1,958.53 / $2,583.61
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.00 / $5,097.00 / $26,542.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.88 / $1,587.86 / $6,294.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.00 / $5,097.00 / $10,764.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.31 / $1,363.22 / $2,408.03