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South Carolina rates for HCPCS 21175

Rcnstj Bifrontal Superior-Lat Orb Rims & Lwr Fhd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,525.11 / $9,062.00 / $18,276.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,993.26 / $2,175.55 / $2,843.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,717.57 / $9,950.93 / $16,952.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,037.21 / $2,990.00 / $4,852.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$890.00 / $890.00 / $2,486.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,295.69 / $2,915.96 / $4,955.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,465.02 / $2,981.52 / $4,866.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.11 / $1,554.05 / $2,926.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,298.00 / $15,713.00 / $25,628.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,835.97 / $2,384.15 / $4,936.13