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South Dakota rates for HCPCS 49452

Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,584.89 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $724.44 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $812.83 / $2,238.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $660.69 / $1,995.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,445.44 / $5,623.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $331.13 / $1,995.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $1,778.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $1,096.48 / $1,513.56
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
$169.82 / $436.52 / $1,905.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $316.23 / $1,737.80