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South Dakota rates for HCPCS 35634

Bypass Graft W/Other Than Vein Iliorenal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,741.90 / $1,741.90 / $1,741.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,618.46 / $1,741.90 / $1,741.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,377.76 / $3,581.52 / $4,476.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,712.39 / $2,735.20 / $4,892.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,070.06 / $3,450.10 / $12,414.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,457.00 / $4,118.35 / $5,398.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,718.44 / $3,773.63 / $5,075.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,199.54 / $2,941.97 / $3,354.18
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
$2,100.51 / $3,450.10 / $4,651.16
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,459.70 / $4,070.20 / $4,233.00