go back

South Dakota rates for HCPCS 15842

Graft for facial nerve paralysis; free muscle flap by microsurgical technique

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,551.94 / $2,551.94 / $2,551.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,223.54 / $2,551.94 / $2,551.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,439.56 / $5,985.83 / $7,482.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,448.36 / $4,030.85 / $6,812.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,478.67 / $5,386.20 / $19,758.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,716.91 / $5,722.66 / $6,798.45
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,009.00 / $5,914.80 / $7,223.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,020.24 / $4,145.82 / $5,257.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,493.64 / $4,774.93 / $7,475.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,818.30 / $5,668.60 / $5,895.30