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South Carolina rates for HCPCS 21422

Open Treatment Palatal/Maxillary Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$721.44 / $9,062.00 / $18,276.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.11 / $719.92 / $994.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,858.23 / $8,787.67 / $13,996.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.72 / $926.00 / $1,420.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.09 / $815.00 / $890.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.48 / $911.95 / $1,569.70
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$701.87 / $883.79 / $1,446.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.30 / $450.29 / $831.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $16,223.00 / $23,485.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.67 / $736.66 / $1,396.59