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South Dakota rates for HCPCS 33697

Compl Rpr T-Fallot W/Pulm Atresia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,064.52 / $2,064.52 / $2,064.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,912.09 / $2,064.52 / $3,009.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,005.99 / $4,247.64 / $5,309.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $3,489.04 / $5,504.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,155.38 / $3,974.56 / $21,818.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,720.00 / $4,822.71 / $6,278.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,565.10 / $4,411.17 / $5,464.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,583.14 / $3,439.01 / $3,920.86
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
$2,155.38 / $3,918.88 / $5,467.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,044.20 / $4,757.89 / $4,948.20