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South Dakota rates for HCPCS 21705

Division of scalenus anticus; with resection of cervical rib

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$495.66 / $495.66 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.76 / $495.66 / $1,257.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.26 / $1,113.33 / $1,391.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.88 / $923.13 / $1,427.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.46 / $1,094.79 / $5,626.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$817.61 / $1,188.84 / $1,647.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$817.61 / $1,157.92 / $1,415.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.57 / $902.73 / $1,029.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.24 / $912.20 / $1,418.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,021.00 / $1,249.30 / $1,249.30