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South Dakota rates for HCPCS 65114

Exntj Orbit Rmvl Orb Cnts W/Musc/Myoq Flap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,694.99 / $1,694.99 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.75 / $1,694.99 / $2,768.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,278.75 / $3,608.01 / $4,510.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.75 / $2,108.17 / $3,900.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,411.61 / $2,763.68 / $4,640.54
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,380.56 / $3,037.48 / $4,034.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,270.37 / $3,471.22 / $4,207.07
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,609.00 / $2,433.94 / $3,024.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,619.54 / $2,944.62 / $4,299.06
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,947.30 / $3,606.10 / $3,606.10