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West Virginia rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.39 / $1,199.01 / $1,700.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.39 / $803.50 / $1,380.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$773.79 / $845.95 / $1,011.66
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.42 / $899.26 / $899.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.23 / $897.23 / $897.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.31 / $1,171.76 / $2,618.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.10 / $1,066.42 / $2,118.57