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South Dakota rates for HCPCS 21275

Secondary revision of orbitocraniofacial reconstruction

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $4,365.16 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $851.14 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,949.84 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,412.54 / $2,187.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,412.54 / $14,791.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,905.46 / $1,905.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $1,862.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,412.54 / $1,659.59
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
$912.01 / $1,513.56 / $2,344.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,949.84 / $1,995.26