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South Dakota rates for HCPCS 15845

Graft for facial nerve paralysis; regional muscle transfer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,023.29 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,454.71 / $3,090.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,584.89 / $2,691.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,819.70 / $9,332.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,344.23 / $2,344.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,737.80 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,778.28 / $2,818.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $2,344.23