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South Dakota rates for HCPCS 63746

Removal of entire lumbosubarachnoid shunt system without replacement

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $3,090.30 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $602.56 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,348.96 / $1,698.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $977.24 / $1,584.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $954.99 / $4,466.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,288.25 / $1,380.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,047.13 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,047.13 / $1,584.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $1,479.11