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Ohio rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $4,677 · 10th–90th $1,175$10,9650%10%10th90th$4,677Professionalmedian $933 · 10th–90th $724$2,0420%20%10th90th$933$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$1,174.90 / $5,888.44 / $10,964.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $933.25 / $4,168.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $3,019.95 / $7,943.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $954.99 / $1,513.56
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $776.25 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,288.25 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,096.48 / $1,659.59
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,096.48 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $131.83
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $4,073.80
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $851.14 / $1,621.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $6,606.93 / $10,471.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $954.99 / $1,479.11