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South Dakota rates for HCPCS 21451

Closed treatment of mandibular fracture; with manipulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$669.63 / $805.86 / $805.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.24 / $669.63 / $1,785.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.11 / $1,801.83 / $2,252.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$791.23 / $1,124.58 / $1,823.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.46 / $1,738.21 / $5,713.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,166.95 / $1,555.46 / $2,020.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,219.50 / $1,528.88 / $2,020.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$783.81 / $1,247.22 / $1,493.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.20 / $1,241.58 / $2,146.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,237.30 / $1,513.90 / $1,813.00