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South Dakota rates for HCPCS 21210

Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,862.09 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,584.89 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,238.72 / $5,248.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $2,187.76 / $4,466.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $4,570.88 / $13,182.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,905.46 / $4,786.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,949.84 / $5,128.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,570.40 / $3,890.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $2,238.72 / $5,495.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,819.70 / $4,073.80