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South Dakota rates for HCPCS 21450

Closed Tx Mandibular Fracture W/O Manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.37 / $622.16 / $622.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.89 / $512.54 / $1,311.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.19 / $1,281.59 / $1,733.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.47 / $831.78 / $1,382.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.45 / $1,311.16 / $4,385.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.64 / $1,089.00 / $1,541.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$935.25 / $1,186.61 / $1,541.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$603.19 / $934.77 / $1,145.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.16 / $1,054.82 / $1,640.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.30 / $1,134.59 / $1,390.60