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South Dakota rates for HCPCS 15574

Frmj Dir/Tube Pedcl W/Wotr Fh/Ch/Ch/M/N/Ax/G/H/F

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$705.33 / $854.04 / $854.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.33 / $854.04 / $1,127.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,487.51 / $1,963.33 / $2,454.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.96 / $1,269.21 / $2,237.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.77 / $2,238.50 / $6,576.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,456.00 / $1,889.37 / $2,364.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.00 / $1,858.62 / $2,352.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$890.22 / $1,414.77 / $1,679.35
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
$838.77 / $1,611.72 / $2,500.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.59 / $1,586.40 / $1,883.10