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South Carolina rates for HCPCS 21175

Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,888.44 / $10,000.00 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,290.87 / $4,897.79
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
$1,905.46 / $2,754.23 / $4,265.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,884.03 / $5,011.87
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $5,128.61
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,951.21 / $4,897.79
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
$1,819.70 / $2,344.23 / $3,801.89