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Minnesota rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$793.34 / $793.34 / $4,828.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.34 / $837.22 / $1,380.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,838.07 / $6,563.86 / $12,629.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,372.94 / $2,193.40 / $2,870.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,932.00 / $2,741.23 / $6,594.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,470.16 / $2,341.94 / $3,478.14
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,756.36 / $2,506.14 / $5,192.43
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,331.04 / $2,093.85 / $3,189.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.22 / $1,405.85 / $4,424.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$943.64 / $1,682.24 / $3,361.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,940.00 / $7,872.00 / $11,531.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$895.05 / $1,629.95 / $3,215.52