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South Dakota rates for HCPCS 21345

Closed treatment of nasomaxillary complex fracture (LeFort II type), with interdental wire fixation or fixation of denture or splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $831.76 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $741.31 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,862.09 / $2,344.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,174.90 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,584.89 / $6,760.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,445.44 / $1,778.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,445.44 / $1,778.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,258.93 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,288.25 / $2,089.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,513.56 / $1,905.46