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Oklahoma 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
$1,439.00 / $4,195.00 / $13,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.77 / $1,663.76 / $1,663.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $900.00 / $900.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,660.47 / $2,116.03 / $2,582.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,576.65 / $2,190.88 / $8,085.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,408.96 / $1,791.02 / $12,979.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,481.00 / $5,910.00 / $9,232.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,326.08 / $1,657.60 / $2,454.91