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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
$1,430.84 / $1,430.84 / $1,430.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,192.19 / $1,430.84 / $3,329.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,474.80 / $3,221.58 / $4,026.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,766.56 / $2,337.23 / $3,840.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.74 / $3,027.17 / $13,577.03
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,230.17 / $3,266.46 / $4,337.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,230.17 / $2,963.68 / $3,775.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,740.19 / $2,404.07 / $2,740.92
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
$1,312.67 / $2,798.82 / $4,024.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,719.10 / $3,326.90 / $3,326.90