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South Dakota rates for HCPCS 21120

Genioplasty; augmentation (autograft, allograft, prosthetic material)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517.71 / $684.52 / $684.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.28 / $585.27 / $1,192.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.23 / $1,452.05 / $1,904.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$728.86 / $958.06 / $1,547.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.82 / $1,435.37 / $4,891.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,114.99 / $1,535.41 / $6,855.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$909.39 / $1,284.33 / $1,668.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.39 / $991.05 / $1,284.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.59 / $1,199.68 / $1,885.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.20 / $1,202.90 / $1,558.60