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South Dakota rates for HCPCS 15050

Pinch Graft 1/Mlt Sm Ulcer Tip/Oth Ar Up To 2 Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.11 / $582.86 / $582.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.37 / $499.32 / $582.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.04 / $1,309.85 / $1,679.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$546.37 / $801.06 / $1,468.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$523.52 / $1,382.40 / $4,336.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$574.51 / $1,015.27 / $1,515.48
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.00 / $1,166.66 / $1,600.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$599.79 / $902.43 / $1,142.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.44 / $882.29 / $1,633.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$827.10 / $1,011.90 / $1,281.09