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South Dakota rates for HCPCS 64616

Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $1,905.46 / $4,365.16
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $134.90 / $281.84
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$181.97 / $371.54 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $302.00 / $389.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $194.98 / $309.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $239.88 / $1,000.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $251.19 / $288.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $229.09 / $269.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $213.80 / $269.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $208.93 / $338.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $263.03 / $331.13