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Louisiana rates for HCPCS 21172

Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $2,754.23 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,238.72 / $3,801.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $10,471.29 / $16,218.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,818.38 / $3,467.37
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,754.23 / $4,073.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $5,248.07 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,187.76 / $3,801.89