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South Dakota rates for HCPCS 64822

Sympathectomy Ulnar Artery

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$683.49 / $683.49 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$580.75 / $683.49 / $1,678.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,218.55 / $1,586.25 / $1,982.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$834.25 / $1,155.09 / $1,804.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.33 / $1,427.03 / $5,185.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,286.63 / $1,849.84 / $3,711.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,048.40 / $1,447.20 / $1,876.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.08 / $1,163.86 / $1,386.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.39 / $1,226.52 / $1,907.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,375.90 / $1,683.50 / $1,683.50