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South Dakota rates for HCPCS 23455

Capsulorrhaphy Anterior W/Labral Repair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.70 / $977.70 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,287.01 / $1,664.67 / $2,617.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,805.90 / $2,416.16 / $10,555.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,227.68 / $1,674.46 / $1,913.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00