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South Dakota rates for HCPCS 21296

Reduction Masseter Muscle & Bone Intraoral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$417.39 / $417.39 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.39 / $417.39 / $963.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.00 / $937.26 / $1,171.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.13 / $657.45 / $1,100.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.36 / $928.54 / $6,589.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$675.62 / $1,012.27 / $3,276.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.00 / $898.11 / $1,094.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.16 / $699.72 / $798.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.90 / $822.86 / $1,132.32
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$791.90 / $968.90 / $968.90