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Indiana rates for HCPCS 21145

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $4,897.79 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,513.56 / $3,235.94
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
$1,288.25 / $1,621.81 / $2,754.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,548.82 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,905.46 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $10,000.00 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,659.59 / $2,884.03