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South Dakota rates for HCPCS D4261

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $269.15 / $269.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $245.47 / $269.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $407.38 / $724.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $398.11 / $1,698.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $489.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95