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Vermont rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,023.29 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,230.27 / $1,862.09
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,230.27 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,174.90 / $3,467.37