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Michigan rates for HCPCS 21154

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,492.28 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.93 / $2,462.52 / $2,588.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,842.42 / $10,378.40 / $14,061.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.05 / $2,020.37 / $3,196.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.93 / $2,355.02 / $4,178.47
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,196.26 / $2,492.28 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,922.10 / $2,196.26 / $3,215.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.84 / $1,340.47 / $2,239.79
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
$2,022.46 / $2,426.94 / $3,264.54