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Indiana rates for HCPCS 21141

Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $21,379.62 / $36,307.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,380.38 / $3,235.94
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $19,952.62 / $27,542.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,548.82 / $2,511.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,348.96 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,659.59 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,479.11 / $2,570.40