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South Dakota rates for HCPCS 21436

Open treatment of craniofacial separation (LeFort III type); complicated, multiple surgical approaches, internal fixation, with bone grafting (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,041.74 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $4,677.35 / $5,754.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $3,388.44 / $5,248.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $3,162.28 / $14,791.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $4,677.35 / $4,677.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $4,168.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $3,388.44 / $3,981.07
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
$2,041.74 / $3,548.13 / $5,623.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $4,677.35 / $4,786.30