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South Dakota rates for HCPCS 65093

Evisceration Ocular Contents W/Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.48 / $803.48 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.22 / $934.04 / $1,741.38
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.16 / $1,495.65 / $2,380.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.21 / $1,044.71 / $1,404.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $7,542.00