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South Carolina rates for HCPCS 21172

Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $10,000.00 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,137.96 / $4,168.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $9,332.54 / $17,378.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,511.89 / $3,548.13
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
$1,949.84 / $2,511.89 / $4,677.35
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $4,897.79
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,511.89 / $4,677.35
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 / $2,089.30 / $3,235.94