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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
$933.25 / $3,019.95 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,818.38 / $4,677.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,311.31 / $4,168.69
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,630.78 / $5,011.87
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
$2,187.76 / $2,951.21 / $4,786.30