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New Mexico rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$805.06 / $7,838.38 / $8,763.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.96 / $861.94 / $3,401.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.69 / $1,281.29 / $1,620.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $1,234.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$757.63 / $1,147.24 / $1,870.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.13 / $1,372.81 / $1,912.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$969.24 / $1,331.12 / $1,925.37