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South Dakota rates for HCPCS 15750

Flap; neurovascular pedicle

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $3,090.30 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,380.38 / $2,398.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $2,089.30 / $2,089.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,548.82 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28