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Michigan rates for HCPCS 21422

Open treatment of palatal or maxillary fracture (LeFort I type);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $5,754.40 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $660.69 / $1,230.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $954.99 / $954.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $954.99 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $794.33 / $1,862.09
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $4,897.79 / $6,025.60
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $741.31 / $1,047.13
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $707.95 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $7,413.10 / $12,882.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $794.33 / $1,023.29