go back

South Dakota rates for HCPCS 15572

Frmj Direct/Tube Pedicle W/Wo Tr Scalp Arms/Legs

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.84 / $855.94 / $855.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.44 / $745.91 / $1,258.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,510.87 / $2,010.86 / $2,513.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$881.51 / $1,241.51 / $2,292.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$791.03 / $2,182.33 / $6,525.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,347.00 / $2,020.81 / $3,929.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,234.00 / $1,826.14 / $2,350.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.96 / $1,440.87 / $1,727.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$791.03 / $1,574.14 / $2,448.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,324.50 / $1,620.50 / $1,936.80