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South Dakota rates for HCPCS 31623

Brnchsc Brushing/Protected Brushings

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.40 / $134.54 / $1,261.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.96 / $294.89 / $747.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.16 / $371.05 / $793.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.65 / $366.12 / $847.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.88 / $727.43 / $2,043.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.27 / $618.00 / $1,386.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.38 / $513.04 / $718.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.36 / $394.52 / $547.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.60 / $561.00 / $760.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.10 / $292.60 / $616.79