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South Dakota rates for HCPCS 21073

Manipulation Tmj Therapeutic Require Anesthesia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.56 / $389.25 / $389.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.14 / $328.34 / $721.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.26 / $712.88 / $1,191.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.00 / $554.89 / $899.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.70 / $876.09 / $2,837.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$518.96 / $648.92 / $996.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$518.96 / $658.45 / $996.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.92 / $524.89 / $793.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.99 / $609.97 / $1,081.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $587.29 / $963.40