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South Carolina rates for HCPCS 21145

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $10,471.29 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,621.81 / $3,981.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $7,585.78 / $14,454.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,778.28 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,995.26 / $3,467.37
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $3,548.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $2,041.74 / $3,548.13
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
$1,288.25 / $1,621.81 / $2,691.53