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Louisiana rates for HCPCS 21147

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)

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
$1,479.11 / $1,862.09 / $2,951.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $8,709.64 / $12,022.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,187.76 / $2,691.53
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,238.72 / $3,162.28
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
$1,412.54 / $1,778.28 / $3,019.95