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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
$955.06 / $2,453.00 / $16,042.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.67 / $955.06 / $1,289.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,641.00 / $10,700.00 / $17,513.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$872.82 / $1,286.50 / $1,775.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$944.16 / $1,295.91 / $1,943.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$925.65 / $1,157.06 / $1,666.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,909.74 / $3,909.74 / $4,634.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,003.81 / $1,250.81 / $2,128.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.90 / $1,098.78 / $1,968.27