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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
$1,995.26 / $4,897.79 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,621.81 / $2,754.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,344.23 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,905.46 / $4,570.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $4,786.30 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,819.70 / $2,511.89
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,698.24 / $2,818.38
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
$1,513.56 / $1,905.46 / $2,511.89