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South Dakota rates for HCPCS 40801

Drg Absc Cst Hmtma Vestibule Mouth Comp

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.72 / $283.83 / $283.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.72 / $283.83 / $456.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.46 / $625.16 / $859.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.39 / $430.75 / $827.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.73 / $814.93 / $2,176.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.00 / $561.67 / $775.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$428.00 / $546.02 / $775.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.82 / $428.28 / $574.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.73 / $558.52 / $851.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.80 / $480.50 / $697.30