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South Dakota rates for HCPCS 64897

Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; up to 4 cm length

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,212.86 / $1,212.86 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,029.18 / $1,212.86 / $3,010.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,148.62 / $2,796.97 / $3,496.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,631.93 / $2,049.75 / $3,350.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,197.68 / $2,633.46 / $9,269.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,945.26 / $3,074.28 / $7,260.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,945.26 / $2,647.54 / $3,394.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,562.65 / $2,119.46 / $2,478.27
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
$1,379.43 / $2,470.88 / $3,461.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,458.50 / $3,008.10 / $3,008.10