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South Dakota rates for HCPCS 22103

Prtl Exc Pst Vrt Intrnsc B1y Les 1 Vrt Sgm Ea

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.16 / $127.16 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.31 / $228.73 / $365.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.15 / $311.56 / $416.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.19 / $233.09 / $273.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$52.76 / $52.76 / $52.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00