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South Carolina rates for HCPCS 21142

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $11,220.18 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $3,388.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $7,585.78 / $14,125.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,698.24 / $4,073.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,778.28 / $3,019.95
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $3,162.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,778.28 / $3,090.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $17,378.01 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,412.54 / $2,398.83