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South Dakota rates for HCPCS 15840

Graft for facial nerve paralysis; free fascia graft (including obtaining fascia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,513.56 / $2,630.27
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,290.87 / $2,290.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,698.24 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28