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South Dakota rates for HCPCS 33503

Rpr Anom Coronary Artery Pulm Art Origin Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,355.07 / $1,355.07 / $1,355.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.01 / $1,355.07 / $1,355.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,647.39 / $2,807.10 / $3,508.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,657.56 / $2,290.07 / $3,462.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,397.17 / $2,559.12 / $12,784.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,173.00 / $2,964.73 / $4,069.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,333.19 / $2,882.07 / $3,536.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,662.41 / $2,232.61 / $2,561.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,524.18 / $2,630.56 / $3,545.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,642.30 / $3,108.60 / $3,232.90