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South Dakota rates for HCPCS 65103

Enucleation Eye Implt Musc X Attached Implt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$952.46 / $952.46 / $3,511.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$773.87 / $1,111.66 / $2,120.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,539.89 / $1,834.25 / $2,715.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$886.49 / $1,259.03 / $1,678.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00