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South Dakota rates for HCPCS 61791

Create Les Strtctc Prq Neurolytic Trigeminal Trc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,033.58 / $1,033.58 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.29 / $1,033.58 / $3,303.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,364.46 / $2,382.48 / $2,978.11
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,264.53 / $1,746.77 / $2,881.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,227.42 / $2,147.98 / $8,693.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,581.22 / $2,312.96 / $3,503.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,726.00 / $2,423.58 / $3,067.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,428.44 / $1,936.13 / $2,245.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $3,905.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,227.42 / $2,104.52 / $2,917.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,227.50 / $2,620.60 / $2,725.40