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South Dakota rates for HCPCS 21390

Optx Orb Floor Blwt Fx Pri/Bital Appr W/Allplstc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.70 / $810.70 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$976.27 / $1,310.41 / $2,095.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,493.19 / $2,108.33 / $6,855.77
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$976.96 / $1,326.91 / $1,560.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00