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South Dakota rates for HCPCS 14020

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$547.71 / $691.29 / $691.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.62 / $646.97 / $918.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,184.33 / $1,627.35 / $2,036.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.57 / $1,002.59 / $1,795.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.89 / $1,715.33 / $5,242.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,127.00 / $1,581.21 / $2,160.75
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,032.00 / $1,429.14 / $1,865.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.33 / $1,113.31 / $1,377.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.74 / $1,372.26 / $1,941.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.30 / $1,248.40 / $1,545.10