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South Dakota rates for HCPCS 21480

Closed Tx Temporomandibular Dislocation 1st/Sbsq

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.77 / $148.91 / $693.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.37 / $130.49 / $253.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.16 / $230.01 / $440.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.24 / $160.54 / $270.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00