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South Carolina rates for HCPCS 21155

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $10,471.29 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,238.72 / $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
$1,862.09 / $2,754.23 / $4,466.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,019.95 / $4,897.79
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $5,011.87
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,019.95 / $5,011.87
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
$1,778.28 / $2,290.87 / $3,890.45