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South Dakota rates for HCPCS 21267

Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $4,365.16 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,621.81 / $3,235.94
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
$1,905.46 / $2,691.53 / $4,168.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,691.53 / $23,988.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,715.35 / $3,715.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,548.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $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
$1,737.80 / $2,884.03 / $4,466.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,090.30 / $3,630.78 / $3,801.89