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South Dakota rates for HCPCS 15841

Graft Facial Nerve Paralysis Free Muscle Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,690.81 / $1,690.81 / $1,690.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,474.13 / $1,690.81 / $1,690.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,612.22 / $3,974.97 / $4,968.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,108.01 / $2,712.58 / $4,498.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,643.99 / $3,536.17 / $13,065.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,750.00 / $3,929.20 / $4,717.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,516.00 / $3,797.77 / $4,770.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,974.08 / $2,714.13 / $3,477.73
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
$1,716.07 / $3,162.83 / $4,919.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,187.30 / $3,749.80 / $3,899.80