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South Dakota rates for HCPCS 35522

Bypass graft, with vein; axillary-brachial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,288.25 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,454.71 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,862.09 / $2,951.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $2,089.30 / $10,232.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $2,511.89 / $2,691.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,089.30 / $2,238.72
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
$1,288.25 / $2,238.72 / $3,235.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,691.53 / $2,818.38