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South Dakota rates for HCPCS 20103

Exploration Penetrating Wound Spx Extremity

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.09 / $575.61 / $8,547.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.36 / $782.05 / $1,310.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.36 / $1,195.08 / $1,706.95
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.56 / $718.33 / $1,088.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $1,643.00 / $1,643.00