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Nebraska rates for HCPCS 21242

Arthroplasty, temporomandibular joint, with allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,241.22 / $8,477.27 / $21,899.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$945.69 / $945.69 / $5,002.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.12 / $1,546.23 / $2,061.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,376.03 / $4,376.03 / $4,376.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,607.00 / $2,318.17 / $3,107.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$945.69 / $1,654.96 / $8,632.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,268.15 / $2,097.33 / $2,865.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,392.00 / $2,376.12 / $5,383.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,609.00 / $2,068.23 / $3,107.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,268.15 / $2,120.23 / $2,731.40