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South Dakota rates for HCPCS 42205

Palatoplasty W/Clsr Alveolar Ridge Soft Tissue

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$903.11 / $903.11 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.35 / $903.11 / $981.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,570.63 / $2,160.44 / $2,700.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$940.81 / $1,622.70 / $2,514.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,082.08 / $1,803.46 / $9,072.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,397.88 / $2,353.92 / $3,276.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,397.88 / $2,120.81 / $2,594.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.96 / $1,505.95 / $1,885.07
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
$1,082.08 / $1,803.46 / $2,718.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,870.10 / $2,288.10 / $2,288.10