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Louisiana rates for HCPCS 21188

Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)

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
$1,412.54 / $1,737.80 / $2,754.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,995.26 / $2,511.89
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,089.30 / $2,951.21
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
$1,380.38 / $1,737.80 / $2,818.38