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South Dakota rates for HCPCS 64612

Chemodnrvtj Musc Musc Innervated Facial Nrv Unil

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.67 / $134.85 / $134.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.67 / $157.55 / $217.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.13 / $312.38 / $390.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.34 / $229.52 / $316.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.12 / $300.87 / $1,721.89
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.42 / $275.72 / $362.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.27 / $275.72 / $356.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.46 / $216.99 / $268.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.08 / $237.06 / $368.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.00 / $282.70 / $325.89