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Virginia rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $3,388 · 10th–90th $832$9,5500%5%10th90th$3,388Professionalmedian $977 · 10th–90th $759$1,9500%10%10th90th$977$500.0$1.0K$2.0K$5.0K$10.0K$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
$1,000.00 / $4,897.79 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $912.01 / $1,778.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $3,981.07 / $4,466.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,148.15 / $1,949.84
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,096.48 / $6,760.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,096.48 / $1,778.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $870.96 / $1,023.29
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,513.56 / $1,819.70
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,122.02 / $1,659.59
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,122.02 / $9,549.93
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,122.02 / $9,549.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,309.57 / $10,471.29 / $21,379.62
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $1,023.29 / $1,621.81