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South Dakota rates for HCPCS 12021

Tx Superficial Wound Dehiscence W/Packing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.74 / $173.69 / $173.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.62 / $156.75 / $197.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.83 / $398.31 / $503.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.77 / $248.16 / $423.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.10 / $397.33 / $1,316.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$255.00 / $375.18 / $516.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.00 / $353.68 / $469.93
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.13 / $265.98 / $342.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.10 / $305.17 / $474.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.00 / $308.30 / $384.50