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South Dakota rates for HCPCS 65875

Severing Ads Ant Seg Incal Spx Post Synechiae

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.99 / $676.99 / $676.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$554.63 / $796.73 / $1,651.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,186.93 / $1,460.99 / $1,920.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.11 / $1,032.76 / $1,216.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00