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South Dakota rates for HCPCS 21147

Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)

Facilitymedian $2,630 · 10th–90th $1,738–$4,3650%20%10th90th$2,630Professionalmedian $2,188 · 10th–90th $1,585–$4,1690%20%10th90th$2,188$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,737.80 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,981.07 / $5,011.87
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,754.23 / $4,466.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $3,090.30 / $15,135.61
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,162.28 / $4,073.80 / $4,073.80
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $3,715.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,818.38 / $3,311.31
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,466.84 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,630.27 / $4,677.35
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,311.31 / $3,981.07 / $3,981.07