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South Dakota rates for HCPCS 21245

Reconstruction of mandible or maxilla, subperiosteal implant; partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,258.93 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,174.90 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,754.23 / $3,630.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,862.09 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,187.76 / $12,022.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,187.76 / $2,754.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,949.84 / $2,454.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,862.09 / $2,344.23
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
$1,071.52 / $1,819.70 / $3,162.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,238.72 / $2,884.03