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New Mexico 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
$1,000.00 / $2,095.00 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,432.12 / $1,624.83 / $5,672.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,524.10 / $2,326.13 / $3,126.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $2,425.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,488.05 / $2,033.18 / $2,946.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,604.23 / $2,486.56 / $3,866.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,653.49 / $2,336.36 / $3,720.33