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Louisiana rates for HCPCS 21193

Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$860.00 / $2,448.00 / $5,150.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,132.13 / $1,541.76 / $2,147.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,490.14 / $6,917.46 / $11,511.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,333.24 / $1,568.52 / $2,317.35
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $1,084.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.27 / $1,700.99 / $2,225.10
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
$1,094.33 / $1,428.35 / $2,553.42