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South Dakota rates for HCPCS 31230

Maxillectomy; with orbital exenteration (en bloc)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,238.72 / $2,754.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $4,570.88 / $5,754.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,884.03 / $5,370.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $3,548.13 / $14,791.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,365.16 / $4,677.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $4,168.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $3,388.44 / $3,890.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,801.89 / $5,623.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $4,365.16 / $4,570.88