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South Dakota rates for HCPCS 21395

Optx Orb Floor Blwt Fx Pri/Bital Appr W/Bone Grf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$999.92 / $999.92 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.47 / $999.92 / $2,386.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,727.27 / $2,248.48 / $2,810.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,201.58 / $1,601.34 / $2,646.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$930.08 / $2,074.59 / $8,440.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,529.60 / $2,286.71 / $3,119.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,529.60 / $2,064.50 / $2,705.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,243.40 / $1,681.42 / $1,967.22
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
$915.17 / $1,798.97 / $2,798.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,951.60 / $2,387.80 / $2,387.80