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South Dakota rates for HCPCS D7111

Extraction Coronal Remnants-Primary Tooth

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.76 / $58.76 / $58.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.67 / $58.76 / $58.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.38 / $95.43 / $99.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.60 / $352.42 / $352.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.00 / $106.96 / $1,562.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.62 / $88.79 / $127.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.80 / $101.80 / $101.80