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South Dakota rates for HCPCS 21180

Rcnstj Forehead &/ Supraorbital Rims W/Autograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,675.73 / $1,675.73 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,401.94 / $1,675.73 / $4,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,897.94 / $3,772.40 / $4,715.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,208.28 / $2,771.77 / $4,061.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,595.58 / $3,203.24 / $17,970.61
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,375.39 / $3,838.52 / $5,244.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,375.39 / $3,330.68 / $4,552.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,917.30 / $2,601.46 / $3,310.19
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
$1,677.89 / $3,050.70 / $4,708.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,283.80 / $4,017.90 / $4,017.90