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South Dakota rates for HCPCS 11004

Dbrdmt Skn Sbq T/M/F Necro Infctj Xtrnl Gent&Per

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$520.01 / $520.01 / $520.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$651.57 / $840.11 / $1,528.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$876.39 / $1,295.91 / $1,750.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.70 / $959.47 / $1,093.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00