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Louisiana rates for HCPCS 21175

Rcnstj Bifrontal Superior-Lat Orb Rims & Lwr Fhd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$860.00 / $2,726.00 / $5,150.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,001.22 / $2,786.52 / $3,925.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,110.52 / $9,340.18 / $14,926.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,362.30 / $2,846.25 / $4,002.66
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $1,889.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,118.04 / $3,063.47 / $3,970.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,172.00 / $5,493.00 / $15,885.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,936.80 / $2,486.48 / $4,668.27