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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
$1,096.48 / $4,365.16 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,096.48 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,511.89 / $3,162.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,819.70 / $3,162.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,905.46 / $10,232.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,454.71 / $2,454.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $2,691.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,862.09 / $2,137.96
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
$1,230.27 / $1,995.26 / $3,311.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,511.89 / $2,570.40