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South Dakota rates for MS-DRG 187

Dental Extractions & Restorations

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,907.70 / $13,907.70 / $13,907.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,690.19 / $11,067.04 / $11,067.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,528.06 / $9,198.62 / $17,146.31
Sanford Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.00 / $950.00 / $950.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,528.06 / $9,198.62 / $16,891.84