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South Dakota rates for HCPCS 40804

Rmvl Embedded Fb Vestibule Mouth Smpl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.53 / $183.89 / $183.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.17 / $166.12 / $326.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.24 / $342.80 / $575.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.46 / $271.73 / $554.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.99 / $527.83 / $1,409.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.56 / $344.13 / $585.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $344.13 / $504.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.15 / $271.39 / $382.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.99 / $373.32 / $557.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.40 / $281.89 / $464.80