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South Dakota rates for HCPCS 42226

Lengthening Palate & Pharyngeal Flap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$873.90 / $873.90 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.07 / $873.90 / $886.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.42 / $2,081.76 / $2,602.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$890.35 / $1,476.89 / $2,518.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.01 / $1,688.51 / $9,218.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,379.33 / $2,232.87 / $6,855.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,321.00 / $1,992.71 / $2,417.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,058.51 / $1,505.04 / $1,771.21
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
$1,081.01 / $1,661.18 / $2,535.17
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.10 / $2,149.90 / $2,149.90