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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
$1,029.35 / $1,029.35 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$858.78 / $1,029.35 / $2,394.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,785.33 / $2,324.06 / $2,905.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,352.34 / $1,717.56 / $2,712.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$981.62 / $2,137.21 / $11,315.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,573.15 / $2,508.05 / $6,855.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,573.15 / $2,107.64 / $2,700.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,241.50 / $1,724.35 / $1,973.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.49 / $2,013.90 / $2,865.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,957.30 / $2,394.90 / $2,394.90