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South Dakota rates for HCPCS 64630

Dstrj Neurolytic Agent Pudendal Nerve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.72 / $252.72 / $252.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.28 / $214.33 / $544.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.36 / $538.54 / $731.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.80 / $362.22 / $587.26
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.02 / $541.71 / $1,898.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$429.77 / $542.44 / $1,123.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.00 / $450.79 / $585.57
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.24 / $376.50 / $501.35
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
$249.02 / $434.00 / $675.11
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.50 / $457.00 / $608.50