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South Dakota rates for HCPCS 63053

Lam Facetec/Foramot Drg Arthrd Lmbr Ea Addl Sgm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.77 / $207.77 / $2,290.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.12 / $299.14 / $422.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$395.46 / $443.46 / $594.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.55 / $390.37 / $445.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00