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South Carolina rates for HCPCS 40701

Plstc Rpr Cl Lip/Nsl Dfrm Prim Bi 1 Stg Px

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,404.27 / $9,622.00 / $18,276.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,051.82 / $1,404.27 / $1,885.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,385.32 / $10,134.33 / $16,952.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.79 / $1,798.00 / $2,357.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,769.93 / $4,769.93 / $4,769.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.64 / $1,356.00 / $1,814.61
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,118.01 / $1,432.36 / $2,074.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,851.65 / $3,851.65 / $3,851.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.11 / $917.93 / $1,376.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $16,959.00 / $23,485.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$874.59 / $1,160.01 / $2,030.02