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South Dakota rates for HCPCS 14021

Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $851.14 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $831.76 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,041.74 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,174.90 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,698.24 / $6,456.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,621.81 / $1,995.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,778.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,412.54 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,380.38 / $2,238.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,548.82 / $1,905.46