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South Dakota rates for HCPCS 21348

Open treatment of nasomaxillary complex fracture (LeFort II type); with bone grafting (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,094.99 / $1,094.99 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.57 / $1,094.99 / $2,595.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,887.67 / $2,457.28 / $3,071.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,447.63 / $1,820.25 / $3,172.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,147.54 / $2,482.55 / $10,299.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,832.35 / $2,482.55 / $3,374.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,832.35 / $2,397.57 / $2,887.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,343.83 / $1,871.29 / $2,133.48
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
$1,301.75 / $2,192.98 / $2,987.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,116.50 / $2,589.60 / $2,589.60