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Indiana rates for HCPCS 21154

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,386.00 / $2,966.88 / $14,063.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.75 / $1,851.23 / $2,474.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,838.00 / $17,380.30 / $25,253.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.55 / $2,519.50 / $3,476.91
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,755.55 / $2,282.21 / $2,633.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.55 / $2,053.10 / $2,633.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,967.24 / $2,575.55 / $4,192.07
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
$1,678.64 / $2,202.69 / $3,973.61