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South Dakota rates for HCPCS 21160

Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); with LeFort I

Facilitymedian $4,365 · 10th–90th $2,818–$6,4570%20%10th90th$4,365Professionalmedian $3,548 · 10th–90th $2,570–$7,5860%10%10th90th$3,548$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
$2,818.38 / $2,818.38 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,818.38 / $5,754.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,495.41 / $6,456.54 / $7,943.28
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $4,677.35 / $6,760.83
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $5,011.87 / $32,359.37
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,495.41 / $6,456.54 / $6,456.54
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,495.41 / $5,495.41 / $6,025.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,388.44 / $4,570.88 / $5,495.41
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
$2,818.38 / $4,466.84 / $7,585.78
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,370.32 / $6,606.93 / $6,606.93