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South Dakota rates for HCPCS 40814

Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.85 / $365.30 / $365.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.85 / $365.30 / $615.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.59 / $825.85 / $1,085.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$364.48 / $546.88 / $1,022.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.66 / $1,029.08 / $2,769.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$591.87 / $872.84 / $2,389.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.00 / $763.83 / $1,002.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.79 / $558.27 / $727.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.96 / $691.18 / $1,075.17
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.79 / $677.60 / $882.60