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South Dakota rates for HCPCS 43634

Gastrectomy, partial, distal; with formation of intestinal pouch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,887.80 / $1,887.80 / $1,887.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,710.12 / $1,887.80 / $2,075.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,272.66 / $4,501.64 / $5,627.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,890.10 / $5,545.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,221.13 / $4,038.42 / $15,268.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,157.79 / $4,746.29 / $6,607.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,436.00 / $4,647.71 / $5,683.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,474.10 / $3,577.51 / $4,131.10
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
$2,221.13 / $4,443.79 / $5,704.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,098.20 / $5,014.30 / $5,014.30