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South Dakota rates for HCPCS 21345

Closed Tx Nasomaxillary Complex Fracture

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$646.98 / $823.04 / $823.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$596.78 / $688.80 / $1,279.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,306.20 / $1,773.80 / $2,309.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$920.02 / $1,164.07 / $1,887.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.49 / $1,778.17 / $6,724.95
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,166.95 / $1,618.14 / $2,087.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.36 / $1,562.56 / $2,087.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.79 / $1,258.86 / $1,570.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.03 / $1,401.86 / $2,180.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,248.80 / $1,528.00 / $1,905.70