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Maryland rates for HCPCS 21242

Arthroplasty, temporomandibular joint, with allograft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.90 / $1,037.45 / $1,170.22
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,106.61 / $1,106.61 / $1,860.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.00 / $728.96 / $2,754.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$949.47 / $1,364.61 / $2,308.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,350.80 / $1,777.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.00 / $847.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.69 / $1,102.92 / $1,935.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$969.05 / $1,204.20 / $1,497.63