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South Dakota rates for HCPCS 33692

Compl Rpr Tetralogy Fallot W/O Pulm Atresia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,960.27 / $1,960.27 / $1,960.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,768.71 / $1,815.01 / $1,960.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,798.79 / $4,027.95 / $5,034.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $3,312.86 / $5,131.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,179.85 / $3,963.36 / $19,208.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,112.00 / $4,375.55 / $5,976.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,323.00 / $4,190.64 / $5,204.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,461.19 / $3,166.32 / $3,724.85
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
$2,179.85 / $3,590.64 / $5,202.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,842.00 / $4,520.00 / $4,700.80