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South Dakota rates for HCPCS 49255

Omntc Epiploectomy Rescj Omentum Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.61 / $724.61 / $724.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$775.66 / $1,224.58 / $2,194.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.85 / $1,785.28 / $2,453.77
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$919.52 / $1,323.44 / $1,555.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00