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South Dakota rates for HCPCS 42200

Palatop Cl Palate Soft&/Hard Palate Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.29 / $7,460.97 / $7,460.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.49 / $900.50 / $3,318.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,515.69 / $2,084.87 / $2,606.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$905.36 / $1,472.48 / $2,405.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.29 / $1,695.48 / $9,862.15
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,312.78 / $2,263.96 / $6,855.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,320.00 / $2,040.75 / $2,495.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,057.20 / $1,429.61 / $1,813.91
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
$932.51 / $1,680.52 / $2,614.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,799.50 / $2,201.69 / $2,201.69