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South Dakota rates for HCPCS 15840

Graft Facial Nerve Paralysis Free Fascial Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$972.35 / $972.35 / $972.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,212.53 / $1,547.09 / $2,645.63
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.00 / $2,488.87 / $3,929.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.69 / $1,671.15 / $1,965.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00