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Montana 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
Professional
Modifier
Low / Median / High Price
$1,644.48 / $2,254.29 / $8,500.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,475.98 / $2,475.98 / $2,475.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,415.31 / $2,475.98 / $2,559.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,227.25 / $1,687.47 / $2,475.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,506.86 / $2,475.98 / $3,260.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,199.63 / $2,630.88 / $2,911.04