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Pennsylvania rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $4,786 · 10th–90th $1,047$8,3180%10%10th90th$4,786Professionalmedian $851 · 10th–90th $724$1,4790%20%10th90th$851$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
$1,047.13 / $4,786.30 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $812.83 / $1,412.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $831.76 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $1,023.29 / $1,698.24
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,122.02 / $1,445.44
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $977.24 / $1,513.56
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $3,630.78 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $812.83 / $1,584.89
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,230.27 / $1,995.26
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$407.38 / $478.63 / $933.25
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $478.63 / $812.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,370.32 / $10,964.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $954.99 / $1,659.59