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Indiana rates for HCPCS 21142

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,291.33 / $4,846.00 / $14,063.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,198.75 / $1,291.33 / $1,743.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.40 / $10,338.00 / $26,304.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,120.24 / $1,627.40 / $2,245.81
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,247.95 / $1,622.34 / $1,871.93
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,247.95 / $1,497.54 / $1,871.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,301.99 / $1,655.37 / $2,870.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,141.30 / $1,489.03 / $2,678.00