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South Dakota rates for HCPCS D7240

Removal Of Impacted Tooth - Completely Bony

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.35 / $211.35 / $1,656.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.40 / $199.40 / $891.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.48 / $343.37 / $357.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.94 / $1,334.79 / $1,334.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.00 / $390.54 / $1,562.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.00 / $376.53 / $454.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.00 / $420.00 / $420.00