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Pennsylvania rates for HCPCS 21242

Arthroplasty Temporomandibular Jt W/Allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.45 / $4,048.00 / $8,451.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.28 / $1,016.94 / $1,470.80
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $26,582.19
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,005.83 / $1,054.01 / $1,898.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,134.56 / $1,134.56 / $1,134.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$957.29 / $1,237.28 / $2,015.93
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,177.64 / $1,562.49 / $2,034.10
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.00 / $4,993.00 / $10,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.28 / $1,057.96 / $5,420.33
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,187.30 / $1,187.30 / $2,079.60
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,134.56 / $1,134.56 / $1,134.56
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$959.49 / $1,241.74 / $2,095.35
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$987.23 / $987.23 / $1,260.38
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$964.02 / $987.23 / $1,260.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,879.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$914.31 / $1,217.79 / $1,913.33