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Louisiana rates for HCPCS 21195

Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation

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
$1,210.66 / $1,743.20 / $2,356.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,267.19 / $8,830.93 / $12,075.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,446.56 / $1,701.83 / $2,431.01
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $1,188.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,278.88 / $1,796.60 / $2,468.28
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
$1,184.39 / $1,498.33 / $2,802.01