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South Carolina rates for HCPCS 21143

Rcnstj Midface Lefort I 3/> Piece W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,618.40 / $9,062.00 / $18,276.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.00 / $1,456.79 / $1,996.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,883.03 / $8,787.67 / $13,996.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,356.04 / $1,719.95 / $4,253.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$890.00 / $890.00 / $1,579.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,498.24 / $1,876.98 / $3,127.57
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,483.00 / $1,889.27 / $3,227.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.60 / $1,011.38 / $1,856.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $16,223.00 / $23,485.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,185.47 / $1,528.18 / $3,126.38