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South Dakota rates for HCPCS 21431

Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $707.95 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,659.59 / $2,041.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,174.90 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,258.93 / $5,128.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,621.81 / $1,621.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,659.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,174.90 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,288.25 / $2,089.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,584.89 / $1,659.59