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Michigan rates for HCPCS 14021

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $3,890.45 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $870.96 / $2,344.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,071.52 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $891.25 / $3,388.44
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,570.40 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $977.24 / $1,621.81
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $812.83 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $3,235.94 / $6,309.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $891.25 / $1,202.26