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South Dakota rates for HCPCS 30920

Ligation arteries; internal maxillary artery, transantral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $954.99 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,041.74 / $2,511.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $1,348.96 / $2,187.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,513.56 / $6,760.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,905.46 / $1,905.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,737.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,412.54 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,584.89 / $2,344.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,905.46 / $1,949.84