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South Dakota rates for HCPCS 19369

Breast reconstruction; with bipedicled transverse rectus abdominis myocutaneous (TRAM) flap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.53 / $1,905.53 / $1,905.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.50 / $1,905.53 / $5,840.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,419.18 / $4,464.24 / $5,580.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,373.09 / $3,220.35 / $5,364.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,390.88 / $3,984.80 / $25,823.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,094.30 / $4,898.32 / $6,221.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,280.00 / $4,419.18 / $5,403.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,517.28 / $3,404.03 / $3,927.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,390.88 / $3,984.80 / $5,610.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,599.90 / $4,235.20 / $4,404.60