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Alaska rates for HCPCS 21247

Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $10,000.00 / $16,982.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,041.74 / $4,786.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $5,370.32 / $6,760.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,570.40 / $10,964.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $5,370.32 / $8,128.31
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $6,456.54 / $9,332.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $2,570.40 / $8,709.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $2,238.72 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $7,413.10 / $9,549.93