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South Dakota rates for HCPCS 65286

Rpr Lac Appl Tissue Glue Wound Cornea&/Sclera

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.19 / $755.92 / $755.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.07 / $614.11 / $1,218.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,026.59 / $1,412.12 / $1,994.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.20 / $810.37 / $1,682.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$611.69 / $1,337.14 / $3,688.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$756.82 / $1,471.44 / $1,852.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,067.67 / $1,309.08 / $1,862.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$674.33 / $949.00 / $1,326.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$774.14 / $1,268.28 / $1,983.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,088.09 / $1,131.59 / $1,582.10