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South Dakota rates for HCPCS 21160

Rcnstj Midface Lefort Iii W/Fhd W/Lefort I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,790.12 / $2,790.12 / $2,790.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,335.77 / $2,790.12 / $6,628.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,790.99 / $6,236.70 / $7,795.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,701.07 / $4,685.35 / $6,822.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,819.12 / $5,623.67 / $32,079.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,186.06 / $6,512.62 / $8,653.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,186.06 / $5,912.10 / $7,476.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,380.28 / $4,623.01 / $5,438.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,819.12 / $5,355.88 / $7,765.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,395.20 / $6,601.20 / $6,601.20