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Michigan rates for HCPCS 21143

Rcnstj Midface Lefort I 3/> Piece W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,785.37 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,267.05 / $1,785.37 / $1,854.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,885.20 / $8,081.20 / $10,948.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.69 / $1,384.65 / $2,346.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,037.61 / $1,602.07 / $3,097.69
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,534.47 / $1,785.37 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,383.14 / $1,572.31 / $2,322.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.88 / $962.11 / $1,608.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,702.00 / $10,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,421.22 / $1,716.68 / $2,419.17