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South Dakota rates for HCPCS 11004

Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $831.76 / $1,513.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,318.26 / $1,318.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,096.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26