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South Dakota rates for HCPCS 43121

Prtl Esophagec W/Wo Prox Gastrec/Pyloroplasty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,499.80 / $2,499.80 / $2,499.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,266.87 / $2,499.80 / $2,769.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,322.76 / $5,946.09 / $7,432.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,673.03 / $3,831.01 / $7,526.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,988.25 / $5,433.18 / $20,305.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,259.42 / $6,365.91 / $8,754.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,047.00 / $6,157.15 / $7,544.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,315.94 / $4,800.20 / $5,472.77
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
$3,250.77 / $5,433.18 / $7,614.43
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,429.20 / $6,642.80 / $6,642.80