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South Dakota rates for HCPCS 63663

Revj Incl Rplcmt Nstim Eltrd Prq Ra Incl Fluor

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.56 / $911.93 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.19 / $1,104.56 / $2,053.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,043.60 / $1,879.79 / $12,124.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.76 / $1,173.54 / $1,719.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$301.64 / $301.64 / $301.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00