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Virginia 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
$1,538.00 / $4,771.00 / $9,347.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,153.00 / $7,363.00 / $9,410.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.00 / $776.00 / $1,178.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.79 / $1,287.41 / $1,495.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,086.38 / $1,469.05 / $2,300.60
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,005.28 / $1,391.18 / $4,677.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,423.00 / $11,475.00 / $21,639.00