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South Dakota rates for HCPCS 64620

Dstrj Neurolytic Agent Intercostal Nerve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.51 / $207.34 / $207.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.53 / $208.00 / $368.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.73 / $483.76 / $604.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.09 / $327.61 / $545.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.89 / $480.92 / $1,600.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$391.55 / $521.79 / $1,123.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.47 / $428.10 / $542.27
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.12 / $340.58 / $412.08
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
$182.83 / $315.57 / $584.39
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.30 / $422.40 / $500.20