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South Dakota rates for HCPCS 69740

Sutr Nrv Itprl W/Wo Grf/Dcmprn Lat Geniculate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,142.94 / $1,142.94 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.48 / $1,142.94 / $3,269.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,531.27 / $2,613.10 / $3,266.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,370.63 / $1,931.57 / $3,209.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,396.44 / $2,327.40 / $9,614.37
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $3,080.36 / $5,269.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.00 / $2,531.27 / $3,141.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,436.66 / $1,952.37 / $2,249.92
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
$1,396.44 / $2,326.14 / $3,202.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,192.69 / $2,579.60 / $2,682.80