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South Dakota rates for HCPCS 40652

Repair Lip Full Thickness <Half Vertical Height

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$343.57 / $504.68 / $1,705.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.60 / $449.84 / $519.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.21 / $1,042.05 / $1,502.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.84 / $739.16 / $1,287.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.32 / $1,228.53 / $3,847.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.47 / $893.05 / $1,320.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.32 / $971.69 / $1,398.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.66 / $737.36 / $1,016.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.54 / $997.01 / $1,422.65
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.70 / $870.80 / $1,233.50