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South Dakota rates for HCPCS 21750

Close Median Sternotomy Sep W/Wo Debridement Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$642.88 / $642.88 / $642.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$854.20 / $1,086.47 / $1,785.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.88 / $1,525.18 / $2,091.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.39 / $1,148.22 / $1,313.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$253.64 / $253.64 / $253.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00