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Wisconsin 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
$1,042.73 / $2,182.32 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,948.00 / $15,579.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,995.29 / $5,995.29 / $5,995.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,746.61 / $3,209.64 / $4,923.66
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,035.35 / $1,500.32 / $2,424.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,042.73 / $2,182.32 / $13,250.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,035.35 / $1,481.98 / $2,424.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.85 / $2,509.85 / $3,746.71
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,994.41 / $5,994.41 / $16,547.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,266.00 / $11,608.00 / $13,980.00