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South Dakota rates for HCPCS 42220

Palatoplasty for cleft palate; secondary lengthening procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$547.95 / $547.95 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.51 / $547.95 / $589.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$955.52 / $1,314.34 / $1,642.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$566.76 / $985.02 / $1,507.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.48 / $1,052.46 / $8,481.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$811.67 / $1,418.05 / $6,855.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.00 / $1,230.28 / $1,560.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.76 / $901.63 / $1,135.31
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
$631.48 / $1,052.46 / $1,637.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,126.30 / $1,378.00 / $1,378.00