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South Dakota rates for HCPCS 49428

Ligation of peritoneal-venous shunt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $389.05 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $446.68 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,202.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $562.34 / $1,380.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $691.83 / $3,090.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,023.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $707.95 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $691.83 / $1,122.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $1,023.29