go back

Montana rates for HCPCS 21242

Arthroplasty, temporomandibular joint, with allograft

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,051.14 / $1,443.75 / $5,420.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,590.55 / $1,590.55 / $1,590.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$839.78 / $1,590.55 / $1,729.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$788.42 / $1,084.07 / $1,590.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$964.35 / $1,590.55 / $2,087.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,372.40 / $1,640.10 / $1,868.80