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South Dakota rates for HCPCS 21408

Open treatment of fracture of orbit, except blowout; with bone grafting (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.98 / $897.98 / $897.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$751.88 / $897.98 / $2,144.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,557.90 / $2,028.00 / $2,535.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,178.85 / $1,481.49 / $2,359.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.10 / $1,848.90 / $7,152.58
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,361.98 / $2,052.81 / $2,789.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,361.98 / $1,888.92 / $2,417.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,106.81 / $1,503.98 / $1,769.27
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
$826.44 / $1,607.67 / $2,500.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.20 / $2,147.50 / $2,147.50