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South Dakota rates for HCPCS 40845

Vestibuloplasty; complex (including ridge extension, muscle repositioning)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,136.35 / $1,415.71 / $1,415.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.18 / $1,268.78 / $3,484.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,717.93 / $3,362.60 / $4,203.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,463.15 / $2,144.23 / $3,888.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,739.00 / $3,912.37 / $11,014.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,450.00 / $3,653.87 / $5,105.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,242.00 / $3,038.74 / $3,918.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,587.97 / $2,357.94 / $2,880.00
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
$1,739.00 / $2,627.71 / $4,087.55
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,339.19 / $2,862.10 / $3,495.70