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South Dakota rates for HCPCS 95873

Electrical stimulation for guidance in conjunction with chemodenervation (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$21.13 / $21.13 / $21.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.13 / $81.15 / $108.23
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$19.32 / $21.13 / $45.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.89 / $144.47 / $180.58
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$31.72 / $39.47 / $48.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $139.38 / $490.88
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.23 / $36.31 / $122.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.66 / $143.60 / $189.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.15 / $115.75 / $136.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$24.29 / $32.34 / $36.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.06 / $139.38 / $163.99
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$20.23 / $36.31 / $42.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.10 / $166.50 / $166.50
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$38.00 / $46.50 / $46.50