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South Dakota rates for HCPCS 63197

Lam W/Cordotomy Sctj Spinothalamic Trc 1stg Thrc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,558.17 / $1,558.17 / $1,558.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,333.77 / $1,558.17 / $4,111.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,755.49 / $3,586.98 / $4,483.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,558.73 / $4,386.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,536.93 / $2,934.14 / $12,163.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,181.28 / $3,566.07 / $5,310.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,181.28 / $3,320.35 / $4,598.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,761.85 / $2,950.90 / $3,397.52
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
$1,536.93 / $2,794.42 / $4,421.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,370.50 / $4,123.89 / $4,123.89