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South Dakota rates for HCPCS 15576

Frmj Direct/Tubed Pedicle W/Wotr E/N/E/L/Ntroral

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.77 / $767.25 / $767.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.50 / $740.42 / $1,159.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,349.45 / $1,761.00 / $2,257.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$787.27 / $1,127.69 / $2,003.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.27 / $1,987.08 / $5,828.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,292.00 / $1,716.91 / $2,364.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,183.00 / $1,642.08 / $2,099.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.28 / $1,269.85 / $1,529.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.88 / $1,430.69 / $2,225.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.80 / $1,424.00 / $1,715.60