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South Dakota rates for HCPCS 75901

Mechanical Rmvl Pericatheter Obstr Matrl Rs&I

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$22.54 / $22.54 / $22.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.91 / $170.91 / $381.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.11 / $525.91 / $657.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.28 / $357.14 / $9,009.00
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$78.31 / $78.31 / $78.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.00 / $440.94 / $588.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.18 / $366.23 / $430.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.98 / $37.45 / $42.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.43 / $357.14 / $408.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.20 / $447.40 / $447.40