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Tennessee rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.23 / $857.03 / $1,321.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,132.00 / $3,728.00 / $5,878.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$843.45 / $1,186.69 / $1,817.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.48 / $1,184.11 / $1,793.69
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,424.10 / $7,909.30 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,294.01 / $6,294.01 / $6,654.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.00 / $6,073.00 / $10,287.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$729.17 / $1,001.89 / $1,791.81