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Indiana 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
$1,380.38 / $4,897.79 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,548.82 / $2,818.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $19,952.62 / $27,542.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,137.96 / $3,311.31
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,584.89 / $1,819.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $2,570.40 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,949.84 / $3,235.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $10,000.00 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,778.28 / $2,951.21