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Utah rates for HCPCS 21490

Open Treatment Temporomandibular Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,322.02 / $4,387.00 / $8,133.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.62 / $1,322.02 / $4,401.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.44 / $1,247.17 / $1,708.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.47 / $474.83 / $748.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,525.68 / $6,104.56 / $8,896.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,026.52 / $1,332.86 / $2,319.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.10 / $927.03 / $1,427.95