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South Dakota rates for HCPCS 21080

Impression & Prepj Definitive Obturator Prosthes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,326.31 / $1,326.31 / $1,688.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.99 / $1,411.17 / $3,993.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,742.08 / $3,597.42 / $4,842.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,872.50 / $2,740.86 / $4,262.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,013.25 / $4,184.63 / $12,434.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,695.45 / $3,439.31 / $4,423.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,891.30 / $3,543.51 / $4,423.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,934.02 / $2,594.07 / $3,288.19
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
$2,013.25 / $3,306.78 / $4,897.79
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,573.40 / $3,148.70 / $3,991.20