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South Dakota rates for HCPCS 15040

Harvest Skin Tissue Cltr Skin Agrft 100 Cm/<

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.93 / $260.52 / $260.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.98 / $333.96 / $650.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.35 / $569.14 / $1,913.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.96 / $361.41 / $505.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00