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New Hampshire rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $2,331.21 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$857.03 / $942.96 / $1,086.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.20 / $1,337.90 / $2,053.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.23 / $2,000.36 / $2,070.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.05 / $1,532.62 / $2,371.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.16 / $1,465.32 / $2,756.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,155.00 / $11,155.00 / $11,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.46 / $1,281.83 / $2,481.73
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.43 / $796.12 / $1,186.42