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South Dakota rates for HCPCS 21125

Augmentation, mandibular body or angle; prosthetic material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$674.77 / $2,776.42 / $2,776.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.96 / $2,250.14 / $4,167.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,406.09 / $3,304.86 / $7,505.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$958.16 / $1,932.79 / $6,165.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,762.20 / $6,824.27 / $19,122.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,665.47 / $5,544.36 / $8,689.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,434.92 / $4,808.49 / $7,090.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.45 / $3,674.16 / $5,219.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,481.40 / $5,157.56 / $8,124.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,307.20 / $1,599.50 / $5,981.70