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Massachusetts rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $3,311 · 10th–90th $977$6,0260%10%10th90th$3,311Professionalmedian $1,000 · 10th–90th $741$2,1380%10%20%10th90th$1,000$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $3,311.31 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $933.25 / $1,995.26
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $5,370.32 / $45,708.82
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,258.93 / $6,606.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,258.93 / $2,398.83
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,023.29 / $3,630.78
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $977.24 / $1,380.38
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,019.95 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,380.38 / $2,238.72
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $5,370.32 / $45,708.82
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,258.93 / $6,606.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $5,370.32 / $12,882.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,348.96 / $2,344.23