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Louisiana rates for HCPCS 21242

Arthroplasty, temporomandibular joint, with allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$841.00 / $2,418.00 / $5,150.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$919.55 / $1,290.20 / $1,743.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,783.10 / $8,674.20 / $11,969.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,085.95 / $1,289.26 / $1,843.90
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $901.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,400.00 / $1,400.00 / $1,400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$968.79 / $1,347.52 / $1,897.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,141.00 / $4,717.00 / $11,696.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$890.47 / $1,130.58 / $1,901.62