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South Carolina rates for HCPCS 25695

Open Treatment Lunate Dislocation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$729.83 / $5,889.00 / $12,172.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.50 / $656.86 / $881.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,866.56 / $6,304.45 / $10,605.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$595.61 / $797.00 / $1,401.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.00 / $726.86 / $5,740.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.55 / $845.88 / $1,410.40
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.12 / $875.80 / $1,392.45
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,727.33 / $4,727.33 / $4,727.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.30 / $450.29 / $844.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,550.00 / $10,257.00 / $16,249.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.77 / $694.48 / $1,447.50