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South Dakota rates for HCPCS 21347

Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approaches

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $4,365.16 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,047.13 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,398.83 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,737.80 / $2,951.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,819.70 / $10,232.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,344.23 / $2,344.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,511.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,778.28 / $2,041.74
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
$1,148.15 / $1,905.46 / $3,162.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,344.23 / $2,454.71