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South Dakota rates for HCPCS 31755

Tracheoplasty; tracheopharyngeal fistulization, each stage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,855.04 / $1,855.04 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,494.56 / $1,855.04 / $4,962.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,773.63 / $3,963.28 / $4,954.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,684.56 / $2,874.27 / $4,490.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,123.23 / $3,538.72 / $12,841.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,782.00 / $4,376.03 / $5,415.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,322.00 / $3,773.63 / $4,689.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,941.53 / $2,860.39 / $3,354.18
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
$2,123.23 / $3,097.73 / $4,818.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,195.30 / $3,759.10 / $3,909.50