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South Dakota rates for HCPCS 13102

Repair Complex Trunk Each Additional 5 Cm/<

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.27 / $114.44 / $114.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.15 / $98.81 / $133.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.65 / $196.72 / $329.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.09 / $161.03 / $313.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.64 / $298.14 / $859.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.00 / $188.94 / $313.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.36 / $210.19 / $314.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.21 / $159.99 / $224.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.11 / $320.74 / $335.10
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.90 / $155.19 / $251.70