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South Dakota rates for HCPCS 43763

Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $331.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $288.40 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $245.47 / $977.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $288.40 / $707.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $537.03 / $2,454.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $213.80 / $812.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $691.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $346.74 / $630.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $257.04 / $724.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $204.17 / $758.58