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South Dakota rates for HCPCS 76805

Us Preg Uterus After 1st Trimest 1/1st Gestation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$48.53 / $48.53 / $48.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.83 / $144.69 / $219.91
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$45.13 / $114.81 / $202.92
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$90.62 / $237.60 / $691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.54 / $314.16 / $392.70
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$70.54 / $107.82 / $134.78
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$135.00 / $206.34 / $257.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.97 / $261.20 / $872.98
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$55.18 / $92.04 / $298.50
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$103.19 / $169.16 / $574.48
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$158.24 / $158.24 / $158.24
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.00 / $293.63 / $345.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.97 / $228.09 / $260.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$58.62 / $80.00 / $91.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$108.93 / $148.09 / $169.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.01 / $189.19 / $287.94
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$51.26 / $65.70 / $103.64
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$103.19 / $164.59 / $194.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.30 / $280.39 / $280.39
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$83.60 / $98.30 / $98.30
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$154.69 / $182.00 / $182.00