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South Dakota rates for HCPCS 33764

Shunt Central W/Prosthetic Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.36 / $1,342.36 / $1,342.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,244.82 / $1,342.36 / $1,342.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,618.73 / $2,776.71 / $3,470.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.46 / $2,268.59 / $3,411.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,386.03 / $2,541.77 / $12,784.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,266.00 / $3,075.39 / $4,039.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,312.04 / $2,855.14 / $3,509.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,651.16 / $2,157.26 / $2,537.79
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
$1,386.03 / $2,473.07 / $3,518.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,617.60 / $3,079.60 / $3,202.70