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South Dakota rates for HCPCS 21247

Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,600.49 / $1,600.49 / $1,600.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.15 / $1,600.49 / $3,734.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,769.86 / $3,605.67 / $4,507.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,111.01 / $2,622.66 / $4,044.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,553.80 / $3,170.96 / $12,979.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,348.55 / $3,723.40 / $4,857.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,348.55 / $3,301.54 / $4,228.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,886.56 / $2,610.92 / $3,071.48
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
$1,660.98 / $2,891.30 / $4,497.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,047.00 / $3,728.10 / $3,728.10