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South Carolina rates for HCPCS 21422

Open treatment of palatal or maxillary fracture (LeFort I type);

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $10,000.00 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $691.83 / $1,412.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $7,585.78 / $14,125.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $831.76 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $891.25 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $891.25 / $1,479.11
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,479.11
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $891.25 / $1,445.44
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
$524.81 / $691.83 / $1,148.15