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Louisiana rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.00 / $2,758.00 / $5,432.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.88 / $1,092.08 / $1,476.03
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,783.10 / $8,674.20 / $11,969.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.01 / $1,088.64 / $1,519.60
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $745.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,650.00 / $1,650.00 / $1,650.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.29 / $1,141.63 / $1,569.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,141.00 / $4,717.00 / $11,696.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.50 / $963.48 / $1,755.40