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South Dakota rates for HCPCS 63103

Vcrpec Lat Xtrcavitary Dcmprn Thrc/Lmbr Ea Seg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.83 / $265.83 / $265.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.30 / $449.27 / $764.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.77 / $645.23 / $903.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.78 / $499.31 / $569.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$110.67 / $110.67 / $110.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00