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Tennessee 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
$1,430.01 / $3,110.49 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,402.74 / $1,627.21 / $2,530.35
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,013.00 / $5,998.00 / $9,419.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,522.55 / $2,106.61 / $3,347.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.52 / $2,233.92 / $3,384.23
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $14,469.20 / $14,764.48
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,979.34 / $12,979.34 / $13,125.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.00 / $6,073.00 / $10,287.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,423.83 / $1,870.29 / $3,289.77