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South Dakota rates for HCPCS L0859

Addition To Halo Procedure Magnetic Resonance Image Compatible Systems Rings And Pins Any Material

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$953.61 / $953.61 / $953.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.16 / $953.61 / $1,250.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.19 / $969.19 / $1,509.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.13 / $1,607.04 / $1,988.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,170.05 / $2,114.07 / $7,148.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.70 / $1,047.78 / $1,714.66
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,255.29 / $1,509.70 / $2,633.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,366.91 / $1,559.87 / $3,280.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,526.41 / $1,787.04 / $2,124.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.11 / $912.94 / $1,521.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,345.00 / $1,345.00 / $1,345.00