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South Dakota rates for HCPCS 35642

Bypass graft, with other than vein; carotid-vertebral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,096.48 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,659.59 / $2,511.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,659.59 / $10,471.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,187.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,659.59 / $1,995.26
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
$1,174.90 / $1,949.84 / $2,630.27
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,290.87 / $2,398.83