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Washington rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $2,188 · 10th–90th $1,072$17,3780%5%10th90th$2,188Professionalmedian $1,202 · 10th–90th $759$2,2390%10%10th90th$1,202$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
$1,479.11 / $7,943.28 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,000.00 / $1,995.26
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,495.41 / $8,912.51 / $17,378.01
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,513.56 / $2,137.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $870.96 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,380.38 / $2,344.23
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,737.80 / $4,466.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,621.81 / $3,388.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $363.08
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $1,584.89 / $1,698.24
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,071.52
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,584.89 / $2,041.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $9,120.11 / $17,378.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,513.56 / $2,089.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $10,471.29 / $19,054.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,258.93 / $2,089.30
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $831.76 / $1,479.11