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South Dakota rates for HCPCS 41870

Periodontal Mucosal Grafting

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.76 / $286.76 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.01 / $286.76 / $6,300.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.96 / $691.84 / $864.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$359.04 / $504.80 / $864.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.44 / $563.76 / $2,251.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.78 / $746.37 / $1,544.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.00 / $598.01 / $759.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.90 / $366.90 / $476.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$299.20 / $563.48 / $831.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,481.30 / $1,481.30 / $1,481.30