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South Dakota rates for HCPCS 40805

Rmvl Embedded Fb Vestibule Mouth Comp

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.29 / $277.70 / $277.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.22 / $248.54 / $663.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.34 / $580.42 / $837.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.01 / $420.03 / $821.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.57 / $805.88 / $2,126.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$424.93 / $521.27 / $762.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.08 / $549.75 / $768.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.72 / $417.19 / $559.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$369.99 / $541.26 / $841.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.50 / $476.60 / $679.20