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South Dakota rates for HCPCS 21453

Closed treatment of mandibular fracture with interdental fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $3,548.13 / $8,912.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,584.89 / $2,187.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $2,187.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,698.24 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84