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South Dakota rates for HCPCS 21049

Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive or destructive lesion[s])

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,174.90 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,691.53 / $3,311.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,041.74 / $10,000.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,754.23 / $2,754.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,691.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,949.84 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,137.96 / $3,311.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,630.27 / $2,754.23