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South Dakota rates for HCPCS 21155

Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I

Facilitymedian $3,388 · 10th–90th $2,138–$5,0120%20%10th90th$3,388Professionalmedian $2,754 · 10th–90th $1,995–$5,4950%20%10th90th$2,754$2.0K$5.0K$10.0K$20.0K

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
$2,137.96 / $2,137.96 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,137.96 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,897.79 / $6,165.95
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $3,630.78 / $5,495.41
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,801.89 / $22,387.21
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,466.84 / $5,011.87 / $5,011.87
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,466.84 / $4,677.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $3,630.78 / $4,168.69
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
$2,344.23 / $3,801.89 / $5,888.44
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,168.69 / $5,128.61 / $5,128.61