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Michigan rates for HCPCS 21750

Closure of median sternotomy separation with or without debridement (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.22 / $4,933.00 / $4,933.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,211.59 / $3,769.47 / $5,107.03
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$748.70 / $870.22 / $6,906.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,635.00 / $10,192.00 / $12,767.00