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Maine rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.34 / $922.13 / $1,056.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$813.28 / $1,052.48 / $1,522.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.38 / $1,232.22 / $1,701.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$994.23 / $1,150.32 / $1,764.66
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.34 / $1,056.21 / $1,086.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.72 / $1,219.09 / $1,764.66