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Michigan rates for HCPCS 21268

Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; combined intra- and extracranial approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,554.31 / $4,933.00 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,768.38 / $2,554.31 / $2,652.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,165.62 / $9,584.03 / $12,984.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.67 / $1,884.86 / $3,354.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,463.07 / $2,203.78 / $4,343.17
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,879.84 / $2,554.31 / $6,906.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,879.84 / $2,161.81 / $3,151.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.00 / $1,371.33 / $2,299.72
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
$1,859.37 / $2,262.16 / $2,899.61