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South Dakota rates for HCPCS 21180

Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $4,365.16 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,698.24 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,890.45 / $4,786.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,818.38 / $4,073.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,570.40 / $17,782.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,890.45 / $3,890.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $3,467.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,630.27 / $3,311.31
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
$1,659.59 / $2,951.21 / $4,677.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,890.45 / $3,981.07