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South Dakota rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $1,349 · 10th–90th $794–$4,3650%20%10th90th$1,349Professionalmedian $1,096 · 10th–90th $724–$2,1380%10%10th90th$1,096$1.0K$2.0K$5.0K

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
$794.33 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $794.33 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,862.09 / $2,344.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,318.26 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,659.59 / $6,309.57
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,041.74 / $2,041.74
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,698.24 / $2,041.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,380.38 / $1,584.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,466.84 / $6,760.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,445.44 / $2,344.23
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,905.46 / $1,905.46