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South Carolina rates for HCPCS 21246

Reconstruction of mandible or maxilla, subperiosteal implant; complete

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $12,022.64 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $891.25 / $1,862.09
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
$758.58 / $1,071.52 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,445.44 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,148.15 / $2,187.76
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,949.84
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,174.90 / $1,949.84
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
$707.95 / $891.25 / $1,513.56