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South Dakota rates for HCPCS 64804

Sympathectomy Cervicothoracic

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,097.09 / $1,097.09 / $1,097.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$938.56 / $1,097.09 / $2,868.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,839.10 / $2,529.73 / $3,162.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.24 / $1,704.87 / $2,439.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.53 / $1,978.90 / $9,520.27
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,346.51 / $2,536.07 / $3,706.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,346.51 / $2,118.33 / $3,200.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.59 / $1,769.56 / $2,373.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.90 / $1,822.49 / $3,078.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,354.60 / $2,880.90 / $2,880.90