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South Dakota rates for HCPCS 33501

Repair of coronary arteriovenous or arteriocardiac chamber fistula; without cardiopulmonary bypass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,230.27 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,778.28 / $2,884.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,905.46 / $12,022.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,511.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,862.09 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $2,137.96 / $2,951.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,570.40 / $2,691.53