go back

South Dakota rates for HCPCS 43622

Gstrct Tot W/Frmj Intstinal Pouch Any Type

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,050.42 / $2,050.42 / $2,050.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,857.24 / $2,050.42 / $2,256.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,553.03 / $4,887.29 / $6,109.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,188.66 / $3,418.43 / $6,033.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,432.66 / $4,375.97 / $16,589.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,423.61 / $5,164.78 / $7,183.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,117.00 / $5,050.17 / $6,177.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,591.89 / $3,891.98 / $4,488.84
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
$2,625.59 / $4,580.47 / $6,201.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,453.10 / $5,448.50 / $5,448.50