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South Dakota rates for HCPCS 21183

Rcnstj Orbit/Fhd/Nasethmd Exc Bone Grf>40 <80

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,262.23 / $2,262.23 / $2,262.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,893.35 / $2,262.23 / $5,446.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,912.99 / $5,093.76 / $6,367.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,986.80 / $3,746.73 / $5,758.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,221.48 / $4,729.16 / $21,431.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,502.25 / $5,273.25 / $7,097.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,502.25 / $4,799.32 / $6,165.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,751.54 / $3,783.03 / $4,481.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,477.17 / $4,503.96 / $6,387.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,445.39 / $5,439.10 / $5,439.10