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South Dakota rates for HCPCS 21421

Closed Tx Palatal/Maxillary Fx W/Fixation/Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.55 / $669.26 / $669.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.62 / $562.55 / $1,521.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,064.11 / $1,516.91 / $1,896.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$736.17 / $960.73 / $1,815.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$753.30 / $1,784.14 / $4,812.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,207.63 / $1,456.84 / $3,276.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,167.14 / $1,383.68 / $1,734.24
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.85 / $1,071.91 / $1,405.24
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
$766.57 / $1,421.75 / $2,033.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,063.40 / $1,301.09 / $1,535.90