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South Dakota rates for HCPCS 39503

Rpr Neonatal Diphrg Hernia W/Wo Chest Tube Insj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,205.02 / $5,205.02 / $5,205.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,137.76 / $5,429.53 / $8,468.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,959.99 / $12,081.14 / $14,951.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,647.10 / $8,682.81 / $16,049.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,806.32 / $11,563.83 / $41,111.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,902.90 / $13,635.52 / $17,805.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,670.00 / $12,465.70 / $15,321.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,721.28 / $9,718.43 / $11,080.10
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
$7,399.81 / $14,968.85 / $15,639.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,991.90 / $12,931.60 / $13,448.90