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South Dakota rates for HCPCS 0686T

Histotripsy Mal Hepatocellular Tiss W/Img Gdn

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,597.24 / $3,597.24 / $3,597.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,546.15 / $3,586.08 / $3,597.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$840.44 / $5,773.12 / $6,832.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,176.20 / $5,189.02 / $11,176.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,653.47 / $16,673.84 / $22,641.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,176.20 / $5,115.47 / $6,960.34