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South Dakota rates for HCPCS 40805

Removal of embedded foreign body, vestibule of mouth; complicated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $275.42 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $245.47 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $602.56 / $851.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $380.19 / $812.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $562.34 / $2,137.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $512.86 / $707.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $436.52 / $616.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $436.52 / $562.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $467.74 / $812.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $478.63 / $676.08