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South Dakota rates for HCPCS 12004

Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.98 / $128.52 / $511.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.98 / $124.14 / $318.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $194.78 / $374.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.86 / $185.21 / $335.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.13 / $313.93 / $1,072.34
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.02 / $290.39 / $342.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.38 / $252.35 / $353.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.43 / $192.44 / $258.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.68 / $253.02 / $355.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.80 / $158.90 / $289.39