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South Dakota rates for HCPCS 21025

Excision of bone (eg, for osteomyelitis or bone abscess); mandible

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $812.83 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $812.83 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,905.46 / $2,398.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,230.27 / $1,995.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,778.28 / $5,888.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,659.59 / $1,995.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,659.59 / $1,995.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,318.26 / $1,584.89
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
$812.83 / $1,445.44 / $2,344.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,584.89 / $1,905.46