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South Dakota rates for HCPCS 21240

Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,778.28 / $2,951.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,570.40 / $2,570.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,778.28 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84