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South Dakota rates for HCPCS 21110

Application of interdental fixation device for conditions other than fracture or dislocation, includes removal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $912.01 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $812.83 / $1,479.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $2,041.74 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,258.93 / $1,905.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,621.81 / $6,309.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,862.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,513.56 / $1,819.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,380.38 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,348.96 / $2,238.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,659.59 / $1,995.26