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South Dakota rates for HCPCS 40720

Plstc Rpr Cl Lip/Nsl Dfrm Sec Recrtj Dfct & Recl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$958.29 / $958.29 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.86 / $958.29 / $1,012.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,092.85 / $2,303.02 / $2,878.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,233.89 / $1,602.83 / $2,887.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$952.40 / $2,114.19 / $7,552.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,681.00 / $2,330.67 / $3,160.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,610.00 / $2,263.46 / $2,757.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.69 / $1,723.77 / $2,011.86
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
$1,081.69 / $1,966.70 / $2,848.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.80 / $2,348.10 / $2,442.00