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South Dakota rates for HCPCS 33871

Transverse aortic arch graft, with cardiopulmonary bypass, with profound hypothermia, total circulatory arrest and isolated cerebral perfusion with reimplantation of arch vessel(s) (eg, island pedicle or individual arch vessel reimplantation)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,265.63 / $3,265.63 / $3,265.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,151.48 / $5,102.63 / $8,125.82
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,440.73 / $7,626.57 / $9,958.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,350.14 / $5,426.61 / $6,186.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00