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Rhode Island rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,424.15 / $3,243.94 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.82 / $997.47 / $1,380.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.08 / $956.50 / $1,810.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$996.35 / $1,388.98 / $1,704.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,219.00 / $7,228.00 / $12,680.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$715.32 / $1,181.40 / $1,822.70