go back

South Dakota rates for HCPCS 64857

Sutr Prph Nrv Arm/Leg Xcp Sciatic W/O Trpos

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.27 / $1,017.27 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.25 / $1,017.27 / $1,807.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,788.92 / $2,328.73 / $2,910.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,353.93 / $1,719.19 / $2,753.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,004.30 / $2,160.86 / $7,734.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,595.76 / $2,565.14 / $7,260.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,595.76 / $2,197.14 / $2,828.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.75 / $1,756.27 / $2,055.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,131.88 / $2,057.10 / $2,894.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,038.80 / $2,494.60 / $2,494.60