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South Dakota rates for HCPCS 22319

Optx&/Rdctj Odntd Fx&/Dislc Ant W/Int Fixj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,703.55 / $1,703.55 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,446.13 / $1,703.55 / $4,395.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,955.39 / $3,847.20 / $4,808.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,235.30 / $2,822.99 / $4,670.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,682.72 / $3,554.67 / $18,574.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,615.42 / $3,930.01 / $5,678.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,615.42 / $3,803.18 / $4,911.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,153.90 / $3,140.62 / $3,632.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,682.72 / $3,036.35 / $4,723.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,604.10 / $4,409.70 / $4,409.70