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South Dakota rates for HCPCS 21146

Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,621.81 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,801.89 / $4,677.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,691.53 / $4,466.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,754.23 / $14,454.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,801.89 / $3,801.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,715.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,754.23 / $3,162.28
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
$1,819.70 / $2,951.21 / $4,570.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,630.78 / $3,801.89