go back

Michigan rates for HCPCS 21047

Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy (eg, locally aggressive or destructive lesion[s])

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,288.25 / $2,570.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $2,754.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $2,754.23 / $2,754.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,548.82 / $3,548.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $3,548.13 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,445.44 / $2,187.76
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,380.38 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $7,413.10 / $12,882.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,548.82 / $2,041.74