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South Dakota rates for HCPCS 12055

Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.69 / $500.77 / $500.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.81 / $397.68 / $500.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.08 / $838.51 / $1,429.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.92 / $645.58 / $1,222.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.13 / $1,150.45 / $3,714.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.18 / $713.47 / $1,305.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.00 / $893.76 / $1,364.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.68 / $664.24 / $971.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.13 / $871.83 / $1,356.18
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.90 / $659.40 / $1,088.80