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South Dakota rates for HCPCS 64902

Nerve graft, each additional nerve; multiple strands (cable) (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.55 / $644.55 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.55 / $644.55 / $1,615.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,134.16 / $1,476.39 / $1,845.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,108.85 / $1,685.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.77 / $1,336.00 / $4,956.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$953.00 / $1,520.79 / $1,815.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$997.29 / $1,431.43 / $1,825.51
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.37 / $1,126.20 / $1,329.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$686.77 / $1,207.94 / $1,879.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.30 / $1,608.10 / $1,608.10