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Indiana rates for HCPCS 21188

Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $2,290.87 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,584.89 / $2,818.38
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
$1,479.11 / $1,905.46 / $3,090.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,584.89 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,995.26 / $3,467.37
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
$1,348.96 / $1,737.80 / $3,019.95