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Louisiana rates for HCPCS 21159

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); without LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$756.00 / $2,694.00 / $4,509.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,333.07 / $3,371.80 / $4,557.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,785.15 / $3,341.10 / $4,658.74
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $2,169.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,494.63 / $3,594.23 / $4,965.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,141.00 / $4,913.00 / $11,696.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,285.78 / $2,994.63 / $5,419.80