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Wyoming rates for HCPCS 21490

Open treatment of temporomandibular dislocation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.94 / $801.50 / $1,007.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,752.00 / $2,752.00 / $2,752.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,506.00 / $1,807.00 / $2,735.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,118.06 / $1,581.89 / $2,194.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,188.00 / $5,188.00 / $18,767.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.46 / $1,655.65 / $3,168.09