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North Carolina 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
$1,547.83 / $2,342.03 / $10,561.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.83 / $1,627.21 / $2,974.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,651.00 / $2,526.14 / $4,223.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $606.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.53 / $2,297.67 / $4,015.40
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,547.83 / $2,017.40 / $3,297.51
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,921.00 / $1,921.00 / $2,035.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.00 / $2,044.50 / $4,474.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,183.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,403.41 / $1,989.12 / $3,911.20
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $14,469.20 / $14,469.20
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,979.34 / $12,979.34 / $13,125.98