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South Dakota rates for HCPCS 21141

Rcnstj Midface Lefort I 1 Piece W/O Bone Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,354.23 / $1,354.23 / $1,354.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,128.01 / $1,378.17 / $60,284.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,341.92 / $3,048.62 / $3,810.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.53 / $2,210.71 / $3,559.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.85 / $2,806.00 / $12,480.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,067.51 / $3,088.36 / $4,100.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,067.51 / $2,776.02 / $3,561.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,637.60 / $2,261.62 / $2,591.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.81 / $2,672.38 / $3,771.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.90 / $3,145.50 / $3,145.50