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South Dakota rates for HCPCS D4260

Osseous Surgery (Including Elevation Of A Full Thickness Flap And Closure) - Four Or More Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.27 / $345.27 / $345.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.93 / $345.27 / $345.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.46 / $583.51 / $776.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$748.68 / $2,436.69 / $2,436.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.99 / $809.50 / $6,855.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.99 / $748.68 / $1,064.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.00 / $999.00 / $999.00