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South Dakota rates for HCPCS 21453

Closed Tx Mandibular Fx W/Interdental Fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$971.37 / $1,146.00 / $1,146.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,146.40 / $1,575.98 / $2,375.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,386.15 / $2,197.54 / $6,855.77
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,074.66 / $1,560.72 / $2,093.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00