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Indiana rates for HCPCS 21242

Arthroplasty, temporomandibular joint, with allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $4,897.79 / $16,218.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,023.29 / $1,819.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $18,197.01 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,288.25 / $2,089.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,023.29 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,621.81 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,202.26 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,096.48 / $1,862.09