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New York rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $4,571 · 10th–90th $1,288$10,2330%5%10th90th$4,571Professionalmedian $955 · 10th–90th $724$2,3990%10%10th90th$955$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $4,265.80 / $10,000.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $977.24 / $2,089.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $4,786.30 / $9,549.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $891.25 / $2,290.87
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,995.26 / $8,912.51
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,862.09 / $50,118.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,412.54 / $3,630.78
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $831.76 / $1,862.09
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,148.15 / $1,584.89
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $758.58
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,047.13 / $1,659.59
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $1,096.48 / $2,089.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $5,495.41 / $12,302.69
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,122.02 / $3,090.30
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $954.99 / $4,073.80
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $977.24 / $2,398.83