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South Dakota rates for HCPCS 15261

Fth/Gft Free W/Dir Clsr N/E/E/L Ea Addl 20 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.80 / $201.96 / $201.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.78 / $173.89 / $201.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$293.31 / $373.97 / $581.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.58 / $286.56 / $554.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.35 / $530.65 / $2,266.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.98 / $416.09 / $551.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.41 / $378.63 / $553.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.43 / $309.50 / $395.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.49 / $424.52 / $586.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.90 / $292.30 / $443.20