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South Dakota rates for HCPCS 21454

Open Tx Mandibular Fx W/External Fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.93 / $495.93 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.05 / $495.93 / $1,182.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.99 / $1,146.83 / $1,433.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$653.22 / $838.12 / $1,510.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.44 / $1,196.64 / $5,937.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$921.73 / $1,287.08 / $8,820.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.66 / $1,095.32 / $1,305.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.60 / $859.20 / $978.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.13 / $979.32 / $1,440.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.80 / $1,181.70 / $1,181.70