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South Dakota rates for HCPCS 75901

Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, radiologic supervision and interpretation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$22.54 / $22.54 / $22.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.91 / $170.91 / $381.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.11 / $525.91 / $657.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.28 / $357.14 / $9,009.00
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$78.31 / $78.31 / $78.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.00 / $440.94 / $588.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.18 / $366.23 / $430.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.98 / $37.45 / $42.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.43 / $357.14 / $408.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.20 / $447.40 / $447.40