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Michigan rates for HCPCS 21159

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); without LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,317.88 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,335.77 / $3,254.73 / $3,445.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,320.80 / $14,460.99 / $19,592.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.43 / $2,775.34 / $4,363.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,952.47 / $3,137.22 / $5,542.75
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,559.05 / $3,317.88 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,551.25 / $2,866.13 / $4,303.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.17 / $1,709.60 / $2,907.94
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
$2,680.80 / $3,257.40 / $4,354.22