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South Dakota rates for HCPCS 65105

Enucleation Eye Implt Musc Attached Implt

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,036.43 / $1,036.43 / $1,036.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$841.18 / $1,208.35 / $2,304.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,688.04 / $2,021.51 / $2,777.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.79 / $1,390.74 / $1,827.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00