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South Dakota rates for HCPCS 11976

Removal Implantable Contraceptive Capsules

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.48 / $140.49 / $140.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.06 / $132.58 / $186.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.57 / $251.26 / $408.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.56 / $201.39 / $372.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.26 / $351.98 / $1,075.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.22 / $242.00 / $383.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.88 / $267.86 / $383.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.94 / $207.00 / $280.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $1,643.00 / $1,643.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.87 / $253.42 / $401.49
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.60 / $200.20 / $314.10