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South Dakota rates for HCPCS 43621

Gstrct Tot W/Roux-En-Y Rcnstj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,021.14 / $2,021.14 / $2,021.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,156.78 / $3,233.64 / $5,924.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,381.26 / $5,086.04 / $7,049.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,552.59 / $3,815.98 / $4,422.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00