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South Dakota rates for HCPCS 21195

Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation

Facilitymedian $2,239 · 10th–90th $1,380–$4,8980%20%10th90th$2,239Professionalmedian $1,778 · 10th–90th $1,230–$3,3110%10%10th90th$1,778$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $4,365.16 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,380.38 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $3,162.28 / $3,890.45
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,238.72 / $3,467.37
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $2,511.89 / $14,454.40
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $3,235.94 / $3,235.94
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $2,951.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,238.72 / $2,570.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,466.84 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $2,290.87 / $3,715.35
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $3,162.28 / $3,162.28