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South Dakota rates for HCPCS 17004

Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.02 / $168.50 / $168.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.79 / $160.84 / $389.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.03 / $283.39 / $484.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.79 / $244.91 / $432.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.63 / $371.90 / $1,248.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.71 / $278.00 / $422.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.88 / $300.57 / $427.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.87 / $241.96 / $323.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.69 / $286.08 / $445.03
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.70 / $216.20 / $362.70