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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
$1,601.85 / $1,601.85 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,334.86 / $1,601.85 / $3,775.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,764.47 / $3,598.66 / $4,498.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,917.53 / $2,634.00 / $4,202.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,497.69 / $3,337.76 / $23,959.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,447.59 / $3,897.24 / $11,523.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,447.59 / $3,331.84 / $4,306.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,916.71 / $2,653.27 / $3,121.29
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
$1,497.69 / $2,896.60 / $4,505.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,096.40 / $3,788.60 / $3,788.60