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South Carolina rates for HCPCS 21154

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,248.07 / $10,471.29 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,137.96 / $4,786.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $7,585.78 / $14,454.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,630.27 / $3,890.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,691.53 / $4,365.16
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $4,570.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $2,691.53 / $4,570.88
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
$1,621.81 / $2,137.96 / $3,467.37