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South Dakota rates for HCPCS 21076

Impression&Preparation Surg Obturator Prosthes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.86 / $705.86 / $873.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.13 / $736.08 / $2,101.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,474.76 / $1,924.54 / $2,540.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,002.39 / $1,427.59 / $2,234.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.24 / $2,189.07 / $6,495.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$841.95 / $1,835.13 / $2,269.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,514.15 / $1,868.72 / $2,269.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,019.65 / $1,397.30 / $1,729.16
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
$954.56 / $1,633.41 / $2,540.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,386.20 / $1,696.00 / $2,098.80