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South Carolina rates for HCPCS 21423

Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve foramina), multiple approaches

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $10,471.29 / $18,197.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $831.76 / $1,949.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $7,585.78 / $14,454.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,000.00 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $1,819.70
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,318.26 / $1,862.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,047.13 / $1,737.80
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
$630.96 / $831.76 / $1,348.96