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South Dakota rates for HCPCS 49605

Repair of large omphalocele or gastroschisis; with or without prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,344.31 / $4,344.31 / $4,344.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,933.53 / $4,344.31 / $5,018.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,518.39 / $10,341.77 / $12,927.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,933.53 / $7,341.88 / $12,876.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,620.01 / $9,378.78 / $35,203.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,342.94 / $10,998.31 / $15,268.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,983.00 / $10,721.90 / $13,129.24
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,393.10 / $8,305.56 / $9,530.12
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
$5,620.01 / $9,134.66 / $13,218.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,454.29 / $11,567.60 / $11,567.60