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South Dakota rates for HCPCS 21048

Exc Benign Tumor/Cyst Maxl Intra-Oral Osteot

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$846.29 / $1,048.41 / $1,899.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,783.17 / $2,296.01 / $2,870.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.68 / $2,389.98 / $9,057.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,751.03 / $2,201.46 / $2,682.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,213.56 / $1,711.85 / $1,964.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$935.62 / $1,925.06 / $2,994.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,936.20 / $2,368.90 / $2,368.90