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South Dakota rates for HCPCS 0412T

Removal of permanent cardiac contractility modulation system; pulse generator only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $223.87 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $363.08 / $3,162.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $407.38 / $1,862.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $407.38 / $630.96