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South Dakota rates for HCPCS 15740

Flap Island Pedicle Anatomic Named Axial Artery

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.83 / $986.25 / $986.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$798.75 / $947.55 / $1,289.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,730.86 / $2,245.29 / $2,906.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,012.68 / $1,434.45 / $2,577.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$902.43 / $2,505.28 / $7,531.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,507.00 / $2,071.96 / $2,638.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.00 / $2,065.76 / $2,677.49
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,093.94 / $1,650.89 / $1,987.28
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
$877.95 / $1,791.86 / $2,787.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.00 / $1,851.20 / $2,228.40