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South Dakota rates for HCPCS 21122

Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$756.04 / $756.04 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.24 / $756.04 / $1,762.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,303.53 / $1,696.88 / $2,121.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$905.34 / $1,238.80 / $1,714.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$698.60 / $1,378.15 / $7,654.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,374.54 / $1,829.99 / $8,689.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,011.17 / $1,431.83 / $2,018.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.27 / $1,089.03 / $1,460.70
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
$721.89 / $1,498.42 / $2,140.17
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,449.10 / $1,773.00 / $1,773.00