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South Dakota rates for HCPCS 19371

Peri-Implant Capsulectomy Breast Complete

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$681.07 / $681.07 / $681.07
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$6,054.31 / $6,054.31 / $6,054.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$849.53 / $1,151.01 / $2,047.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,287.00 / $1,877.65 / $2,691.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$963.66 / $1,230.69 / $1,403.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00