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South Dakota rates for HCPCS 75805

Lymphangiography Pelvic/Abdominal Unilat Rs&I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,137.58 / $3,137.58 / $3,137.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.61 / $2,818.61 / $3,137.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.52 / $719.85 / $899.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.01 / $4,037.10 / $5,302.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$685.94 / $1,557.40 / $4,824.77
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.04 / $520.00 / $6,627.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.84 / $563.52 / $6,627.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.32 / $313.32 / $313.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,448.74 / $3,092.05 / $3,750.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,575.30 / $6,559.20 / $6,559.20