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South Carolina rates for HCPCS 21242

Arthroplasty, temporomandibular joint, with allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $9,120.11 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,071.52 / $2,187.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $9,332.54 / $17,378.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,479.11 / $2,089.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,258.93 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,348.96 / $2,398.83
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $2,290.87
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,348.96 / $2,344.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $17,378.01 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,047.13 / $1,778.28