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South Dakota rates for HCPCS 41872

Gingivoplasty Each Quadrant Specify

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.73 / $460.89 / $460.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.08 / $410.91 / $460.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.41 / $886.23 / $1,373.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.83 / $560.80 / $988.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.27 / $836.72 / $3,487.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.02 / $791.87 / $1,154.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $735.30 / $1,051.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.11 / $604.20 / $899.50
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
$439.91 / $764.12 / $1,261.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.40 / $733.40 / $1,115.80