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South Dakota rates for HCPCS 42280

Maxillary Impresj Palatal Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.66 / $174.33 / $174.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.65 / $154.09 / $180.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.81 / $312.61 / $512.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.07 / $221.35 / $431.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.68 / $344.93 / $1,315.68
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.73 / $288.12 / $476.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.95 / $294.25 / $476.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.54 / $232.19 / $339.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.68 / $265.83 / $505.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.50 / $257.50 / $414.60