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South Dakota rates for HCPCS C1765

Adhesion Barrier

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.46 / $3.46 / $3.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.46 / $3.46 / $379.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.98 / $217.98 / $217.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.85 / $542.05 / $1,038.61