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South Dakota rates for HCPCS 43771

Laps Gastric Restrictive Px Revision Device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,149.30 / $1,149.30 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.27 / $1,149.30 / $1,251.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.43 / $2,744.77 / $3,430.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,270.27 / $2,080.54 / $3,310.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.15 / $2,352.62 / $9,854.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,896.97 / $2,850.20 / $3,988.86
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,896.97 / $2,811.49 / $3,434.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,330.60 / $2,132.23 / $2,498.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,338.84 / $2,214.83 / $3,445.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,479.10 / $3,033.20 / $3,033.20