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South Dakota rates for HCPCS 42200

Palatoplasty for cleft palate, soft and/or hard palate only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $7,413.10 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $977.24 / $3,235.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,137.96 / $2,691.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,318.26 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,380.38 / $9,772.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,187.76 / $2,238.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $1,819.70 / $1,819.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,445.44 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,445.44 / $2,511.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,187.76 / $2,187.76