go back

South Dakota rates for HCPCS 21143

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,445.44 / $3,235.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $3,311.31 / $4,168.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,344.23 / $3,801.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,454.71 / $13,489.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $3,388.44 / $3,388.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $3,235.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,398.83 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,570.40 / $4,073.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,235.94 / $3,311.31