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Oklahoma rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,048.00 / $3,803.00 / $12,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.34 / $826.98 / $826.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,334.45 / $14,829.12 / $23,429.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,248.01 / $2,248.01 / $2,248.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.69 / $1,097.03 / $1,481.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$826.98 / $1,292.36 / $8,110.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.17 / $986.53 / $6,294.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,481.00 / $5,524.00 / $9,232.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.28 / $900.74 / $1,257.99