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South Dakota rates for HCPCS 15769

Grafting Of Autologous Soft Tiss By Direct Exc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$458.38 / $458.38 / $6,714.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.98 / $458.38 / $2,284.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.41 / $1,082.17 / $1,352.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.92 / $678.28 / $1,215.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.15 / $992.59 / $3,547.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$777.18 / $1,262.85 / $4,599.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.68 / $1,100.00 / $1,366.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.62 / $827.84 / $943.83
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
$519.92 / $955.78 / $1,327.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.00 / $1,017.70 / $1,058.40