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South Carolina rates for HCPCS 21143

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $10,471.29 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,621.81 / $3,548.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $7,585.78 / $14,454.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,584.89 / $3,801.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,862.09 / $3,162.28
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $3,235.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,819.70 / $3,235.94
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
$1,174.90 / $1,479.11 / $2,454.71