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Michigan rates for HCPCS 21155

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $4,897.79 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,187.76 / $3,801.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $3,235.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $3,235.94 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,630.27 / $4,677.35
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $4,897.79 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,398.83 / $3,311.31
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,570.40 / $3,801.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $7,943.28 / $14,791.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,630.27 / $3,467.37