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South Dakota rates for HCPCS 40702

Plstc Rpr Cl Lip/Nsl Dfrm Prim Bi 1 2 Stgs

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.61 / $933.61 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$841.03 / $933.61 / $933.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.16 / $2,246.15 / $2,807.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,164.23 / $1,531.81 / $2,811.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$928.37 / $1,991.96 / $7,507.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,498.00 / $2,291.02 / $5,269.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.62 / $1,979.16 / $2,683.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,164.89 / $1,575.24 / $1,961.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.24 / $1,787.70 / $2,774.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,945.80 / $2,289.19 / $2,380.69