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Louisiana 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
$933.25 / $2,691.53 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,584.89 / $2,691.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $6,918.31 / $11,748.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,778.28 / $2,187.76
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $1,202.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,862.09 / $2,570.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $5,370.32 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,479.11 / $2,398.83