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South Dakota rates for HCPCS 64616

Chemodenervation Muscle Neck Unilat For Dystonia

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.26 / $130.25 / $130.25
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$3,043.59 / $3,043.59 / $3,043.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.82 / $112.29 / $202.30
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$415.80 / $415.80 / $415.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.27 / $292.16 / $377.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.90 / $189.35 / $306.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.66 / $286.43 / $1,000.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.08 / $249.05 / $331.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.80 / $254.21 / $330.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.09 / $207.13 / $271.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.18 / $213.37 / $355.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.70 / $261.50 / $329.00