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South Dakota rates for HCPCS 61791

Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg, alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,096.48 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,454.71 / $3,019.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,479.11 / $2,884.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,862.09 / $8,709.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,398.83 / $2,511.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,344.23 / $2,344.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,949.84 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $2,041.74 / $2,818.38
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,630.27 / $2,754.23