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Washington 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])

Facilitymedian $3,162 · 10th–90th $1,585$18,6210%10%10th90th$3,162Professionalmedian $1,778 · 10th–90th $1,122$3,4670%10%20%10th90th$1,778$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $6,025.60 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,621.81 / $3,162.28
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $15,488.17 / $31,622.78
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,344.23 / $3,311.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $758.58 / $8,317.64
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $2,041.74 / $3,630.78
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $2,570.40 / $7,079.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $2,454.71 / $5,370.32
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $147.91
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,398.83 / $2,570.40
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $1,778.28
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,454.71 / $3,235.94
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $16,218.10 / $31,622.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,344.23 / $3,388.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $17,378.01 / $33,884.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,862.09 / $3,235.94
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,230.27 / $2,238.72