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South Dakota rates for HCPCS 64642

Chemodenervation One Extremity 1-4 Muscle

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.12 / $147.21 / $1,342.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.45 / $129.84 / $299.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.69 / $291.19 / $430.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.49 / $214.02 / $362.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.96 / $324.13 / $1,122.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.34 / $258.01 / $374.85
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.39 / $283.43 / $374.85
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $212.43 / $299.51
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
$157.16 / $257.81 / $401.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.30 / $253.60 / $363.50