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South Dakota rates for HCPCS 21206

Osteotomy Maxilla Segmental

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.62 / $982.67 / $2,320.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,982.25 / $2,237.58 / $2,796.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,059.60 / $2,536.94 / $10,915.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,817.39 / $2,376.14 / $2,718.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,260.53 / $1,672.13 / $2,107.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,254.94 / $1,976.09 / $3,235.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,891.20 / $2,314.00 / $2,314.00