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South Dakota rates for HCPCS 21079

Impression & Preparation Interim Obturator Prost

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$981.76 / $1,236.31 / $3,513.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,438.35 / $3,182.00 / $4,256.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,762.12 / $3,699.32 / $10,902.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,572.67 / $3,114.17 / $3,827.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,710.82 / $2,306.85 / $2,891.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,337.18 / $2,753.24 / $4,282.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,288.50 / $2,800.00 / $3,509.80