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Pennsylvania rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.00 / $3,066.00 / $7,799.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$704.32 / $798.78 / $1,168.30
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $26,582.19
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.96 / $829.11 / $1,677.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.23 / $897.23 / $897.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$753.74 / $1,019.71 / $1,732.05
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$928.80 / $1,230.03 / $1,604.28
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,839.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.72 / $971.73 / $3,834.16
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.20 / $897.20 / $1,924.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.23 / $897.23 / $897.23
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.31 / $1,037.53 / $1,771.65
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.18 / $767.18 / $934.30
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.69 / $767.18 / $934.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,879.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.46 / $1,001.00 / $1,669.59