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Michigan rates for HCPCS 21180

Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $5,754.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,698.24 / $3,162.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $512.86 / $512.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $2,570.40 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,949.84 / $4,786.30
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $4,897.79 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,778.28 / $2,511.89
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,819.70 / $3,090.30
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
$1,584.89 / $1,949.84 / $2,570.40