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South Dakota rates for HCPCS 64640

Destruction by neurolytic agent; other peripheral nerve or branch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $1,148.15 / $2,290.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $234.42 / $602.56
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$380.19 / $389.05 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $346.74 / $741.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $302.00 / $426.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $316.23 / $1,862.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $229.09 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $208.93 / $295.12
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $251.19 / $478.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $245.47 / $549.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $281.84 / $588.84