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South Dakota rates for HCPCS 42890

Limited Pharyngectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,350.17 / $1,350.17 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,331.13 / $2,037.31 / $3,980.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,218.27 / $3,479.52 / $6,855.77
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,582.45 / $2,370.12 / $2,742.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00