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South Dakota rates for HCPCS 42815

Exc Branchial Cleft Cyst Below Subq Tiss&/Phrynx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.66 / $515.66 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.79 / $912.79 / $1,542.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$854.87 / $1,334.36 / $6,855.77
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.52 / $924.29 / $1,053.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00