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South Dakota rates for HCPCS 64901

Nerve Graft Each Nerve 1 Strand

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$556.48 / $556.48 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.36 / $556.48 / $1,396.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.41 / $1,275.39 / $1,594.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.11 / $958.15 / $1,456.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.89 / $1,148.20 / $4,282.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$857.53 / $1,313.87 / $1,560.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$857.53 / $1,230.21 / $1,575.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$694.70 / $973.32 / $1,148.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$531.30 / $1,043.01 / $1,622.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.90 / $1,389.80 / $1,389.80