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South Dakota rates for HCPCS 64862

Suture Lumbar Plexus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,315.19 / $1,315.19 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,115.88 / $1,315.19 / $3,265.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,329.96 / $3,033.04 / $3,791.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,769.98 / $2,222.67 / $3,125.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,344.50 / $2,778.64 / $10,052.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,053.96 / $3,254.26 / $7,260.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,053.96 / $2,736.59 / $3,679.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,617.94 / $2,284.83 / $2,687.87
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
$1,344.50 / $2,416.23 / $3,755.50
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,666.50 / $3,262.50 / $3,262.50