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Montana rates for HCPCS 21242

Arthroplasty, temporomandibular joint, with allograft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,412.54 / $2,691.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,412.54 / $1,737.80
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,737.80 / $2,137.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,737.80 / $2,137.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,479.11 / $2,041.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,412.54 / $2,089.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,659.59 / $1,949.84