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Missouri rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.00 / $4,261.00 / $8,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.55 / $791.58 / $2,535.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.00 / $1,052.33 / $1,540.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.50 / $1,145.07 / $1,894.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$760.96 / $1,287.83 / $8,656.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.18 / $1,187.45 / $6,294.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,156.00 / $4,000.00 / $10,781.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$789.22 / $1,073.32 / $1,698.55