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South Dakota rates for HCPCS 13122

Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.72 / $124.56 / $1,295.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.73 / $108.73 / $412.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.47 / $225.94 / $357.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.33 / $176.63 / $344.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.88 / $300.23 / $937.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.97 / $216.59 / $339.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.40 / $230.24 / $343.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.43 / $180.38 / $243.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.88 / $235.46 / $365.79
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.30 / $177.70 / $273.50