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South Carolina rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$903.87 / $8,783.00 / $16,639.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.81 / $903.87 / $1,228.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,717.57 / $9,950.93 / $16,952.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.88 / $941.76 / $1,612.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.00 / $890.00 / $2,279.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$945.00 / $1,208.17 / $1,926.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$901.30 / $1,119.00 / $1,909.28
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,747.48 / $1,747.48 / $1,747.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.30 / $584.59 / $1,055.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $16,223.00 / $23,485.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.67 / $963.55 / $1,754.88