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West Virginia rates for HCPCS 21242

Arthroplasty, temporomandibular joint, with allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$973.29 / $1,400.00 / $2,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$973.29 / $1,049.35 / $1,555.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$968.49 / $1,061.41 / $1,266.22
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.52 / $1,125.53 / $1,125.53
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
$968.79 / $1,459.39 / $2,927.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.87 / $1,186.59 / $1,634.08