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South Dakota rates for HCPCS 15004

Prep Site F/S/N/H/F/G/M/D Gt 1st 100 Sq Cm/1pct

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.77 / $385.59 / $385.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.16 / $362.86 / $497.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.57 / $724.56 / $1,117.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.26 / $563.21 / $1,044.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.20 / $911.09 / $2,910.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.13 / $723.27 / $1,061.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.41 / $764.02 / $1,061.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.07 / $566.70 / $760.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$146.44 / $146.44 / $146.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.11 / $691.51 / $1,116.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.00 / $566.50 / $852.30