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South Dakota rates for HCPCS 61640

Balloon dilatation of intracranial vasospasm, percutaneous; initial vessel

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.52 / $440.52 / $440.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$375.48 / $440.52 / $440.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.72 / $999.59 / $1,249.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.17 / $744.48 / $2,000.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.33 / $932.22 / $5,741.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,019.63 / $1,151.51 / $1,460.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.67 / $1,126.28 / $1,456.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$605.89 / $794.93 / $1,035.66
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
$559.33 / $932.22 / $1,307.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.10 / $1,057.80 / $1,100.09