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South Dakota rates for HCPCS 21700

Division of scalenus anticus; without resection of cervical rib

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$334.15 / $334.15 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.95 / $334.15 / $1,033.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.04 / $751.83 / $939.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.75 / $639.41 / $956.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.11 / $740.94 / $4,674.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.92 / $953.00 / $8,250.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.42 / $776.57 / $948.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.85 / $605.41 / $690.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.81 / $578.91 / $950.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.70 / $837.80 / $837.80