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South Dakota rates for HCPCS 42815

Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $4,365.16 / $4,897.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $831.76 / $1,548.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,258.93 / $1,348.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $891.25 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84