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South Dakota rates for HCPCS 21179

Rcnstj Forehead &/ Supraorb Rims W/Algrf/Prostc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,501.99 / $1,501.99 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,256.69 / $1,501.99 / $3,599.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,598.09 / $3,382.07 / $4,227.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,977.99 / $2,519.76 / $3,540.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,405.78 / $2,805.47 / $15,972.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,083.26 / $3,439.00 / $4,695.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,083.26 / $3,100.43 / $4,075.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,670.95 / $2,222.46 / $2,964.74
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
$1,405.78 / $2,671.88 / $4,212.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,941.10 / $3,598.60 / $3,598.60