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North Carolina rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.81 / $1,442.13 / $8,413.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.81 / $803.50 / $1,555.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.07 / $1,742.00 / $2,448.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $2,393.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.36 / $1,228.50 / $2,266.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.81 / $1,084.77 / $1,737.63
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.00 / $1,149.00 / $1,149.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $1,036.20 / $2,479.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,183.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.17 / $1,027.89 / $2,124.02
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,424.10 / $7,909.30 / $26,542.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,294.01 / $6,294.01 / $6,654.15