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Louisiana rates for HCPCS 21196

Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $2,498.00 / $5,858.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.96 / $1,783.01 / $2,460.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,776.22 / $6,649.90 / $11,281.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,531.03 / $1,819.00 / $2,680.52
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $1,266.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,366.86 / $1,964.51 / $2,702.16
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
$1,226.33 / $1,609.77 / $2,926.16