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South Dakota rates for HCPCS 65091

Evisceration Ocular Contents W/O Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$809.66 / $809.66 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.61 / $941.78 / $1,762.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.31 / $1,512.38 / $2,380.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$752.97 / $1,056.24 / $1,416.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00