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Michigan rates for HCPCS 21261

Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intra- and extracranial approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,089.43 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,132.17 / $3,089.43 / $3,208.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,968.13 / $5,831.13 / $7,900.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.89 / $2,274.21 / $4,047.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,766.14 / $2,553.37 / $5,231.14
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,275.89 / $3,089.43 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,275.89 / $2,617.27 / $3,816.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.20 / $1,640.16 / $2,764.07
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
$2,310.02 / $2,730.61 / $3,563.31