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South Dakota rates for HCPCS 42650

Dilation Salivary Duct

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.96 / $72.38 / $72.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.72 / $64.64 / $79.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.12 / $162.40 / $214.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.95 / $109.24 / $212.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.62 / $175.85 / $555.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.38 / $146.02 / $200.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.10 / $153.69 / $200.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.25 / $117.09 / $144.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.28 / $149.80 / $220.33
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.20 / $142.10 / $176.70