go back

South Dakota rates for HCPCS 21188

Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,621.81 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,754.23 / $3,715.35 / $4,570.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,630.27 / $4,168.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,754.23 / $15,488.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,801.89 / $3,801.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,630.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,630.27 / $3,090.30
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
$1,778.28 / $2,951.21 / $4,570.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,548.13 / $3,715.35