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
$1,550.00 / $2,877.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,126.85 / $1,361.39 / $1,609.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.39 / $5,597.88 / $7,584.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.32 / $1,504.07 / $3,144.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.46 / $1,512.33 / $2,739.21
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,321.13 / $2,877.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,196.30 / $1,367.20 / $2,010.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.47 / $850.32 / $1,384.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,702.00 / $10,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,290.07 / $1,560.97 / $2,179.85