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South Dakota rates for HCPCS 40761

Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (Abbe-Estlander type), including sectioning and inserting of pedicle

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,005.18 / $1,005.18 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$904.53 / $1,005.18 / $1,111.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,193.38 / $2,413.65 / $3,017.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,293.48 / $1,671.08 / $3,033.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$998.47 / $2,157.21 / $9,006.77
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.00 / $2,629.84 / $5,269.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,676.00 / $2,376.98 / $2,896.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.80 / $1,664.70 / $2,112.78
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
$1,053.13 / $1,914.78 / $3,000.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,096.00 / $2,465.80 / $2,564.50