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South Dakota rates for HCPCS 40831

Closure of laceration, vestibule of mouth; over 2.5 cm or complex

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.33 / $256.88 / $648.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.80 / $587.25 / $866.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.77 / $958.31 / $2,192.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.32 / $552.71 / $837.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$296.61 / $431.66 / $578.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.97 / $643.64 / $1,001.22
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.70 / $482.90 / $702.80