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South Dakota rates for HCPCS 40842

Vestibuloplasty; posterior, unilateral

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.02 / $800.36 / $1,762.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,375.04 / $1,742.26 / $2,374.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.70 / $2,293.69 / $6,882.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,200.00 / $1,655.00 / $2,141.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.80 / $1,208.24 / $1,612.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$896.23 / $1,635.89 / $2,544.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,193.70 / $1,460.50 / $1,957.50