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South Dakota rates for HCPCS 21485

Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequent

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$834.10 / $1,025.08 / $1,025.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.82 / $834.10 / $1,805.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,390.91 / $2,094.84 / $2,776.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$824.91 / $1,327.24 / $1,839.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.35 / $1,682.87 / $7,097.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,059.98 / $1,584.29 / $2,350.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,059.98 / $1,552.94 / $2,207.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$873.56 / $1,286.06 / $1,829.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.60 / $1,434.53 / $2,519.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.00 / $1,817.00 / $2,220.50