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South Dakota rates for HCPCS 33853

Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic material; with cardiopulmonary bypass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,041.74 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $4,897.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $2,884.03 / $4,677.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $3,162.28 / $22,387.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $4,073.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $3,090.30 / $3,548.13
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
$1,905.46 / $3,467.37 / $4,897.79
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $4,265.80 / $4,466.84