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Maryland rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $851.14 / $2,137.96
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $831.76 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,071.52 / $1,862.09
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $831.76 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $851.14 / $2,884.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $977.24 / $1,659.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $891.25 / $1,148.15