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South Dakota rates for HCPCS 13121

Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.72 / $897.60 / $3,058.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.46 / $412.18 / $969.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.04 / $729.43 / $1,219.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.74 / $593.10 / $1,093.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.73 / $1,055.75 / $3,161.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.13 / $720.76 / $1,142.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.00 / $782.13 / $1,148.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.91 / $610.59 / $818.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.73 / $777.47 / $1,209.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.50 / $562.20 / $918.40