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South Dakota rates for HCPCS 21433

Open treatment of craniofacial separation (LeFort III type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approaches

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,709.57 / $1,709.57 / $1,709.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,431.34 / $1,709.57 / $4,111.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,961.98 / $3,855.77 / $4,819.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,253.81 / $2,828.57 / $4,500.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,596.34 / $3,575.67 / $12,714.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,641.52 / $3,920.05 / $5,350.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,641.52 / $3,542.75 / $4,642.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,134.62 / $2,904.48 / $3,385.23
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
$1,872.97 / $3,091.10 / $4,808.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,358.30 / $4,109.00 / $4,109.00