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South Dakota rates for HCPCS 49084

Peritoneal Lavage W/Wo Imaging Guidance

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.24 / $95.24 / $3,073.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.07 / $160.96 / $295.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.83 / $270.58 / $1,182.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.36 / $182.70 / $208.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00