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Michigan rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $851.14 / $1,479.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $1,258.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $1,258.93 / $1,905.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $977.24 / $2,398.83
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,897.79 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $977.24 / $1,348.96
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $954.99 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $7,413.10 / $12,882.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $977.24 / $1,288.25