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Michigan rates for HCPCS 21188

Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,001.56 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,423.63 / $2,001.56 / $2,078.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,658.02 / $8,988.26 / $12,177.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.92 / $1,576.54 / $2,711.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.93 / $1,861.65 / $3,515.08
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,625.49 / $2,001.56 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,551.63 / $1,755.50 / $2,596.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.00 / $1,077.72 / $1,781.93
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
$1,536.81 / $1,925.55 / $2,688.35