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South Dakota rates for HCPCS 21151

Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,819.70 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $4,168.69 / $5,128.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $3,019.95 / $5,370.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $3,235.94 / $18,197.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $4,168.69 / $4,168.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $4,466.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $3,090.30 / $3,467.37
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
$2,089.30 / $3,467.37 / $5,623.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $4,073.80 / $4,265.80