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South Dakota rates for HCPCS 21296

Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); intraoral approach

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $2,290.87 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $416.87 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $954.99 / $1,202.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $676.08 / $1,096.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $724.44 / $6,606.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $933.25 / $933.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,000.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $691.83 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $794.33 / $1,258.93
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $933.25 / $977.24