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South Dakota rates for HCPCS 40701

Plastic repair of cleft lip/nasal deformity; primary bilateral, 1-stage procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $4,365.16 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,202.26 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,754.23 / $3,388.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,862.09 / $3,311.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,238.72 / $8,709.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,754.23 / $2,754.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,995.26 / $2,344.23
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
$1,071.52 / $2,137.96 / $3,311.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,818.38