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South Dakota rates for HCPCS 42335

Sialolithotomy Submndblr Submax Comp Intraoral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.44 / $425.62 / $425.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.92 / $379.01 / $425.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$441.79 / $759.62 / $1,245.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.76 / $544.45 / $986.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.84 / $788.15 / $3,228.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.00 / $684.13 / $1,082.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.72 / $708.59 / $1,082.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.25 / $539.44 / $829.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.04 / $788.15 / $1,137.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$516.60 / $632.10 / $1,013.70