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South Dakota rates for HCPCS 21179

Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic material)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $4,365.16 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,513.56 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,467.37 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,511.89 / $3,548.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,290.87 / $15,848.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,467.37 / $3,467.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $3,019.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,344.23 / $2,951.21
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
$1,479.11 / $2,630.27 / $4,168.69
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $3,467.37 / $3,630.78