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Louisiana rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $3,388.44 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $2,290.87 / $4,073.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $6,606.93 / $11,481.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,513.56 / $3,981.07
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,862.09 / $4,570.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $2,754.23 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $2,041.74 / $4,265.80