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South Dakota rates for HCPCS 35122

Dir Rpr Ruptd Aneursm Hepatic/Celiac/Renal/Mesen

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,861.70 / $1,861.70 / $1,861.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.25 / $1,861.70 / $1,861.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,609.95 / $3,827.72 / $4,784.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $3,146.27 / $5,724.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,278.03 / $4,141.88 / $13,276.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,559.00 / $4,404.13 / $5,772.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,257.00 / $4,034.90 / $4,999.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,381.94 / $3,145.67 / $3,692.97
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
$2,278.03 / $3,658.59 / $4,970.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,699.20 / $4,352.00 / $4,526.10