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Texas rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $3,631 · 10th–90th $912$11,7490%5%10%10th90th$3,631Professionalmedian $933 · 10th–90th $724$1,6220%10%10th90th$933$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
$870.96 / $3,630.78 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $912.01 / $1,412.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $4,365.16 / $8,317.64
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $851.14 / $1,698.24
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $691.83 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,122.02 / $1,862.09
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,471.29 / $45,708.82 / $45,708.82
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,606.93 / $6,606.93 / $6,606.93
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $1,230.27 / $4,265.80
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,023.29 / $1,698.24
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $100.00 / $676.08
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $933.25 / $933.25
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $1,096.48 / $1,905.46
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,122.02 / $1,819.70
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $6,025.60 / $11,481.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $933.25 / $1,445.44
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $707.95 / $741.31