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South Dakota rates for HCPCS 61630

Balloon Angioplasty Intracranial Percutaneous

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,255.58 / $1,255.58 / $1,255.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,525.35 / $2,000.00 / $3,443.42
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,988.37 / $3,225.55 / $4,198.47
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,686.91 / $2,261.73 / $2,660.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00