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South Dakota rates for HCPCS 20101

Exploration of penetrating wound (separate procedure); chest

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $602.56 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $426.58 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $645.65 / $1,621.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $537.03 / $1,023.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $870.96 / $4,570.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $467.74 / $1,023.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $446.68 / $977.24
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $588.84 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $537.03 / $1,288.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $501.19 / $1,318.26