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South Dakota rates for HCPCS 21260

Periorbital Osteotomies Bone Grafts Extracranial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,368.49 / $1,368.49 / $1,368.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,140.80 / $1,368.49 / $3,229.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,362.28 / $3,075.11 / $3,843.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,638.76 / $2,135.03 / $3,084.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,269.25 / $2,594.94 / $14,907.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,491.63 / $3,236.61 / $6,855.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,911.52 / $2,757.96 / $3,682.24
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,447.46 / $2,070.44 / $2,669.11
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
$1,359.26 / $2,716.44 / $3,852.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,647.90 / $3,239.70 / $3,239.70