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South Dakota rates for HCPCS 19370

Revision Peri-Implant Capsule Breast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$643.15 / $643.15 / $975.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.99 / $1,086.92 / $1,789.40
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$5,610.98 / $5,610.98 / $5,610.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.00 / $1,765.47 / $2,691.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$825.66 / $1,138.93 / $1,322.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00