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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
$977.24 / $977.24 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,023.29 / $1,621.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,258.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,479.11 / $5,754.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $16,595.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,148.15 / $1,621.81