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South Dakota rates for HCPCS 21081

Impression and custom preparation; mandibular resection prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,214.79 / $1,557.66 / $2,489.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,512.69 / $3,456.28 / $4,461.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,849.24 / $3,848.49 / $11,498.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,665.05 / $3,237.87 / $4,060.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,772.93 / $2,378.00 / $3,029.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,849.24 / $3,059.78 / $4,500.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,359.10 / $2,886.40 / $3,677.10