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South Dakota rates for HCPCS 75809

Shuntogram Indwelling Nonvascular Shunt Rs&I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$23.26 / $23.26 / $23.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.47 / $88.51 / $140.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.79 / $189.27 / $236.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.19 / $169.90 / $758.00
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$74.81 / $74.81 / $74.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.44 / $190.41 / $211.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.14 / $137.88 / $163.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.75 / $38.58 / $43.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.86 / $158.82 / $198.52
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.69 / $163.19 / $163.19