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Nebraska 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
$4,241.22 / $10,431.19 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,476.23 / $1,476.23 / $8,500.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,086.90 / $11,951.75 / $23,118.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,413.59 / $2,409.54 / $3,212.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,702.00 / $3,605.67 / $4,857.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,476.23 / $2,583.40 / $7,441.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,996.11 / $3,255.85 / $4,497.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,812.15 / $3,660.80 / $4,894.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,763.00 / $3,280.80 / $4,857.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,996.11 / $3,255.85 / $4,242.29