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South Dakota rates for HCPCS 21246

Reconstruction of mandible or maxilla, subperiosteal implant; complete

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$861.85 / $861.85 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.79 / $861.85 / $2,011.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,492.66 / $1,943.08 / $2,428.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,135.76 / $1,438.73 / $2,368.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.22 / $1,812.38 / $13,243.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,585.97 / $2,105.37 / $6,855.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,336.55 / $1,725.74 / $2,273.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,045.11 / $1,451.41 / $1,654.77
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
$757.09 / $1,554.39 / $2,417.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,641.60 / $2,008.50 / $2,008.50