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South Dakota rates for HCPCS 21256

Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,230.27 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,818.38 / $3,548.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $2,041.74 / $3,235.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $2,041.74 / $14,791.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,818.38 / $2,818.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,691.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,041.74 / $2,454.71
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
$1,318.26 / $2,238.72 / $3,467.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,818.38 / $2,951.21