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Missouri 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
$1,593.14 / $5,389.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.04 / $1,593.14 / $2,535.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,224.00 / $4,490.00 / $12,405.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,565.95 / $1,944.50 / $3,035.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,540.82 / $2,146.84 / $3,562.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,332.04 / $2,230.40 / $4,813.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,581.64 / $2,234.46 / $12,979.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $4,000.00 / $11,258.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,491.84 / $2,072.00 / $3,255.85