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Michigan rates for HCPCS 21423

Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve foramina), multiple approaches

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $4,897.79 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $831.76 / $1,479.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $1,202.26 / $1,202.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $933.25 / $2,290.87
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $2,454.71 / $6,918.31
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $933.25 / $1,288.25
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $831.76 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $7,413.10 / $12,882.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,230.27