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South Dakota rates for HCPCS 21452

Percutaneous treatment of mandibular fracture, with external fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.23 / $791.55 / $791.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.14 / $638.92 / $1,183.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.35 / $1,328.37 / $2,118.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$571.92 / $908.01 / $1,491.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.79 / $1,387.46 / $5,506.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.01 / $1,484.63 / $8,779.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.15 / $1,133.43 / $1,706.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$653.03 / $947.80 / $1,387.60
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
$637.79 / $1,387.46 / $2,018.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.90 / $1,063.20 / $1,684.30