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South Dakota rates for HCPCS 0613T

Perq Tcat Impltj Intratrl Septal Shunt Device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,120.08 / $1,120.08 / $1,120.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,120.08 / $1,120.08 / $1,151.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,567.93 / $1,567.93 / $1,832.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,647.05 / $1,892.95 / $2,000.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,396.62 / $2,372.60 / $8,541.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,385.02 / $1,724.22 / $1,996.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,567.93 / $1,745.11 / $2,115.13
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
$1,193.26 / $2,141.37 / $3,331.02