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South Dakota rates for HCPCS 64517

Injection Anes Superior Hypogastric Plexus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.15 / $196.00 / $196.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.93 / $178.99 / $314.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.04 / $360.33 / $559.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.28 / $280.08 / $454.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.08 / $441.38 / $2,563.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.77 / $441.38 / $1,123.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.04 / $327.39 / $472.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.19 / $269.35 / $375.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $1,643.00 / $1,643.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.90 / $347.54 / $540.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.90 / $298.39 / $455.40