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South Dakota rates for HCPCS 40700

Plastic repair of cleft lip/nasal deformity; primary, partial or complete, unilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $6,309.57 / $13,489.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,047.13 / $3,630.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,344.23 / $2,884.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $2,818.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,905.46 / $10,000.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,290.87 / $2,290.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $1,905.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,698.24 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,778.28 / $2,818.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $2,398.83