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South Dakota rates for HCPCS 49062

Drg Xtraperitoneal Lymphocele Periton Cavity Opn

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$693.72 / $693.72 / $693.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.05 / $693.72 / $752.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,208.70 / $1,662.60 / $2,078.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$752.11 / $1,172.39 / $2,000.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.64 / $1,420.10 / $5,578.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.29 / $1,697.22 / $2,394.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.29 / $1,662.95 / $2,066.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.61 / $1,242.21 / $1,508.57
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
$726.92 / $1,277.17 / $2,071.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,496.60 / $1,831.10 / $1,831.10