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South Dakota rates for HCPCS 21462

Open treatment of mandibular fracture; with interdental fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,208.08 / $2,082.67 / $2,082.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,426.92 / $2,614.92 / $4,633.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,484.52 / $4,213.93 / $8,704.82
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,675.51 / $2,792.52 / $3,793.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00