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South Dakota rates for HCPCS 31225

Maxillectomy W/O Orbital Exenteration

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,885.77 / $1,885.77 / $1,885.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,768.70 / $2,587.10 / $4,918.95
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,835.31 / $4,439.93 / $5,595.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,191.64 / $3,067.93 / $3,497.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00