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Nebraska rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,083.97 / $8,477.27 / $19,276.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.82 / $734.82 / $4,401.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,522.85 / $8,579.33 / $16,595.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$710.19 / $1,210.55 / $1,614.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,091.67 / $2,091.67 / $2,091.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,362.00 / $1,830.89 / $2,402.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$734.82 / $1,291.25 / $7,221.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.09 / $1,713.55 / $2,505.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,089.00 / $2,035.33 / $2,649.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,396.16 / $1,823.16 / $2,402.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.09 / $1,769.34 / $2,231.60