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South Dakota rates for HCPCS 21050

Condylectomy Temporomandibular Joint Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$883.07 / $4,338.00 / $13,573.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.43 / $883.07 / $2,362.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,527.37 / $1,988.26 / $2,485.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,120.77 / $1,433.00 / $2,216.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.11 / $1,731.87 / $7,988.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,274.75 / $2,141.44 / $6,855.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,274.75 / $1,792.56 / $2,321.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,034.46 / $1,431.94 / $1,684.53
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
$814.10 / $1,721.62 / $2,478.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,671.10 / $2,044.70 / $2,044.70