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South Dakota rates for HCPCS 40843

Vestibuloplasty; posterior, bilateral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.50 / $1,148.46 / $1,148.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$731.80 / $1,026.58 / $2,408.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,951.65 / $2,439.56 / $3,417.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,051.23 / $1,734.92 / $2,877.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,295.41 / $3,037.38 / $8,857.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,685.00 / $2,687.38 / $5,105.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,542.00 / $2,222.92 / $2,862.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,204.07 / $1,745.44 / $2,287.75
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
$1,295.41 / $2,266.96 / $3,309.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,694.20 / $2,072.90 / $2,841.60