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South Dakota rates for HCPCS 23020

Capsular Contracture Release

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$689.90 / $689.90 / $3,073.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$903.30 / $1,165.93 / $1,796.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,035.39 / $1,701.46 / $3,711.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.82 / $1,166.89 / $1,372.72
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$255.45 / $255.45 / $255.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00