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Massachusetts 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
$1,402.74 / $2,747.00 / $5,039.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,402.74 / $1,584.56 / $2,530.35
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,591.00 / $5,032.85 / $13,133.71
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,625.19 / $2,860.69 / $12,979.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,617.78 / $2,720.65 / $4,584.74
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $2,486.48 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,805.86 / $2,187.48 / $2,978.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,944.78 / $3,679.72 / $4,843.67
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $5,063.00 / $13,773.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,740.58 / $2,889.68 / $12,979.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.00 / $5,097.00 / $10,764.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,712.04 / $2,456.23 / $4,572.18