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Wisconsin rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Facilitymedian $4,786 · 10th–90th $2,344$12,0230%10%10th90th$4,786Professionalmedian $1,259 · 10th–90th $741$3,7150%10%20%10th90th$1,259$50.0$200.0$1.0K$5.0K

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
$776.25 / $1,659.59 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $794.33 / $1,995.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,311.31 / $4,897.79 / $9,332.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,621.81 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,398.83 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $3,235.94 / $3,715.35
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,737.80 / $5,754.40
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,949.84 / $2,511.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,778.28 / $13,489.63
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,621.81 / $6,309.57
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $9,332.54 / $15,848.93
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $2,137.96 / $3,548.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,698.24 / $2,570.40
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,370.32 / $7,943.28 / $7,943.28
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $4,073.80 / $6,309.57
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $2,570.40 / $2,570.40
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $4,677.35 / $5,011.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,760.83 / $12,022.64 / $14,454.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,318.26 / $3,388.44