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South Dakota rates for HCPCS 21110

Appl Interdental Fixation Device Non-Fx/Dislc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$747.76 / $905.32 / $905.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.85 / $797.40 / $1,646.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,350.62 / $1,992.68 / $2,491.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$877.81 / $1,254.72 / $2,000.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.30 / $1,858.54 / $6,368.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,134.63 / $1,599.43 / $2,167.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,221.74 / $1,599.43 / $2,167.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$879.71 / $1,354.77 / $1,651.54
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
$889.78 / $1,510.69 / $2,349.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,360.50 / $1,664.60 / $2,004.60