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South Dakota rates for HCPCS 39503

Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,365.16 / $5,248.07 / $5,248.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,623.41 / $6,309.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $15,135.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $7,762.47 / $15,848.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,370.32 / $10,000.00 / $40,738.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,302.69 / $12,589.25 / $13,182.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,760.83 / $9,772.37 / $10,964.78
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
$6,309.57 / $10,715.19 / $15,488.17
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,964.78 / $12,882.50 / $13,489.63