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South Dakota rates for HCPCS 21242

Arthroplasty, temporomandibular joint, with allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,365.16 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,023.29 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,398.83 / $2,951.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,698.24 / $2,691.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,737.80 / $11,220.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,398.83 / $2,398.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,290.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,698.24 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,862.09 / $2,884.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,290.87 / $2,398.83