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South Dakota rates for HCPCS 21172

Rcnstj Superior-Lateral Orbital Rim & Lower Fhd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,978.40 / $1,978.40 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,652.75 / $1,978.40 / $3,188.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,401.87 / $4,428.39 / $5,535.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,402.23 / $3,117.89 / $4,582.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,849.61 / $3,990.48 / $15,018.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,935.44 / $4,456.84 / $6,581.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,935.44 / $3,848.96 / $5,676.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,183.89 / $3,103.60 / $4,162.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $11,831.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,863.58 / $3,366.12 / $5,423.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,129.70 / $5,052.80 / $5,052.80