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South Dakota rates for HCPCS 49425

Insertion Peritoneal-Venous Shunt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$706.11 / $706.11 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.72 / $706.11 / $708.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.65 / $1,691.43 / $2,114.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$763.75 / $1,193.33 / $2,000.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.52 / $1,384.73 / $5,666.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,091.13 / $1,645.30 / $2,155.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.00 / $1,618.39 / $1,887.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.00 / $1,222.48 / $1,531.86
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
$824.49 / $1,347.58 / $1,958.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,519.70 / $1,859.40 / $1,859.40