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New York rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $4,265.80 / $10,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $977.24 / $2,137.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $4,786.30 / $10,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $891.25 / $2,290.87
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,995.26 / $8,912.51
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,348.96 / $3,548.13
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $831.76 / $1,862.09
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,122.02 / $1,584.89
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,047.13 / $1,659.59
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $1,096.48 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $5,888.44 / $13,489.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,000.00 / $2,511.89
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $954.99 / $4,073.80
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $977.24 / $2,398.83