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South Dakota rates for HCPCS 43502

Gastrotomy W/Sutr Rpr Pre-Esopg/Gastric Lac

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,363.07 / $1,363.07 / $1,363.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,234.77 / $1,363.07 / $1,490.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,365.29 / $3,253.52 / $4,066.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,483.28 / $2,303.59 / $3,974.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.14 / $2,861.84 / $11,001.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,236.21 / $3,403.46 / $4,752.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,215.00 / $3,347.87 / $4,091.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,719.85 / $2,563.90 / $2,975.74
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
$1,717.10 / $2,861.84 / $4,099.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,952.00 / $3,611.90 / $3,611.90