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South Dakota rates for HCPCS 14021

Adjt/Rearrgmt Scalp/Arm/Leg 10.1-30.0 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$683.41 / $849.21 / $849.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$672.10 / $809.37 / $1,139.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,464.52 / $2,004.62 / $2,505.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$859.66 / $1,252.95 / $2,212.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$871.00 / $2,142.94 / $6,464.24
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,469.00 / $1,840.86 / $2,364.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,344.00 / $1,777.78 / $2,300.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$922.90 / $1,389.54 / $1,701.99
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
$942.90 / $1,549.08 / $2,409.67
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,273.50 / $1,558.20 / $1,908.50