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South Dakota rates for HCPCS 15101

Split Agrft T/A/L Ea 100 Cm/Ea 1% Bdy Inft/Chld

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.01 / $181.63 / $181.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.91 / $256.14 / $477.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.86 / $345.19 / $496.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.02 / $266.23 / $357.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00