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South Dakota rates for HCPCS 42600

Closure salivary fistula

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.14 / $534.75 / $534.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.37 / $475.94 / $534.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.59 / $1,020.62 / $1,566.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$414.27 / $750.47 / $1,263.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.35 / $991.12 / $4,072.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$775.00 / $1,130.06 / $2,389.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$720.41 / $954.41 / $1,366.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.29 / $701.89 / $1,048.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.07 / $919.80 / $1,430.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$696.30 / $851.90 / $1,281.40