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South Dakota rates for HCPCS 64400

Injection Aa&/Strd Trigeminal Nerve Each Branch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.32 / $191.97 / $719.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.32 / $95.29 / $157.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.68 / $142.47 / $319.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.51 / $161.04 / $278.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.06 / $284.00 / $1,030.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.94 / $187.88 / $305.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.26 / $190.11 / $305.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.72 / $156.34 / $218.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.84 / $190.75 / $313.20
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.80 / $123.30 / $264.60