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South Dakota rates for HCPCS 40844

Vestibuloplasty Entire Arch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,101.19 / $1,436.14 / $1,436.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$991.82 / $1,286.00 / $3,115.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,491.59 / $3,310.20 / $4,284.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,424.75 / $2,173.34 / $3,430.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,540.91 / $3,611.24 / $11,116.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,215.00 / $3,611.04 / $5,105.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,028.00 / $2,779.87 / $3,629.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,533.40 / $2,194.94 / $2,868.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,686.56 / $3,611.24 / $4,150.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,294.30 / $2,807.10 / $3,573.40