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Michigan rates for HCPCS 21263

Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,855.44 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,898.65 / $2,855.44 / $2,965.27
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
$600.72 / $2,187.48 / $3,870.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,633.69 / $2,309.17 / $4,842.64
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.43 / $2,855.44 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.43 / $2,271.77 / $3,525.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.30 / $1,471.09 / $2,529.29
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
$2,017.57 / $2,390.66 / $3,223.44