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South Dakota rates for HCPCS 21183

Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 40 sq cm but less than 80 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,290.87 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $5,248.07 / $6,456.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,801.89 / $5,754.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,801.89 / $21,379.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $5,248.07 / $5,248.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,786.30 / $4,786.30 / $5,011.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,801.89 / $4,466.84
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
$2,454.71 / $4,073.80 / $6,456.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,466.84 / $5,248.07 / $5,495.41