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South Dakota rates for HCPCS 21386

Open Tx Orbital Floor Blowout Fx Periorbital

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$689.71 / $689.71 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.90 / $689.71 / $1,650.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,201.79 / $1,564.43 / $1,955.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$896.79 / $1,157.80 / $1,824.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.23 / $1,432.70 / $6,008.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,053.49 / $1,578.83 / $2,135.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.49 / $1,395.76 / $1,851.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.26 / $1,160.40 / $1,362.37
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
$747.06 / $1,163.35 / $1,809.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,351.50 / $1,653.60 / $1,653.60