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South Carolina rates for HCPCS 21242

Arthroplasty Temporomandibular Jt W/Allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,161.26 / $8,960.00 / $16,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$919.55 / $1,061.08 / $1,407.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,717.57 / $9,950.93 / $16,952.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$937.23 / $1,463.00 / $2,602.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.00 / $1,134.56 / $4,769.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,140.23 / $1,397.64 / $2,464.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,134.05 / $1,393.74 / $2,292.08
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,851.65 / $3,851.65 / $3,851.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.30 / $731.11 / $1,319.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $16,223.00 / $23,485.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.52 / $1,128.10 / $2,248.98