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South Dakota rates for HCPCS 49402

Removal of peritoneal foreign body from peritoneal cavity

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $3,090.30 / $9,549.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,148.15 / $2,344.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $2,041.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,412.54 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28