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South Dakota rates for HCPCS 64734

Transection/Avulsion Infraorbital Nerve

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$486.51 / $486.51 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.41 / $486.51 / $1,240.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.98 / $1,132.03 / $1,415.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.47 / $738.94 / $1,275.24
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.20 / $992.92 / $3,726.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.89 / $1,143.64 / $2,173.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$682.00 / $913.28 / $1,370.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$543.05 / $865.38 / $1,030.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $3,905.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.57 / $852.75 / $1,326.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,022.30 / $1,250.80 / $1,250.80