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South Dakota rates for HCPCS 21740

Repair Pectus Excavatum/Carinatum Open

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$967.15 / $967.15 / $967.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$817.51 / $967.15 / $2,422.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,901.22 / $2,176.03 / $2,720.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,286.91 / $1,690.07 / $2,686.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.91 / $2,050.52 / $11,477.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,526.28 / $2,297.60 / $3,163.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,526.28 / $2,236.52 / $2,729.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,279.07 / $1,731.90 / $1,987.92
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
$1,038.91 / $1,769.67 / $2,752.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,972.10 / $2,412.90 / $2,412.90