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South Dakota rates for HCPCS 21175

Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts)

Facilitymedian $3,715 · 10th–90th $2,188–$4,8980%20%10th90th$3,715Professionalmedian $2,818 · 10th–90th $2,042–$5,4950%20%10th90th$2,818$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
$2,187.76 / $4,365.16 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,187.76 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $5,011.87 / $6,309.57
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $3,630.78 / $5,011.87
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,981.07 / $19,498.45
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
$2,344.23 / $3,630.78 / $4,265.80
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
$1,995.26 / $3,630.78 / $6,025.60
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $5,248.07 / $5,248.07