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South Dakota rates for HCPCS 20101

Exploration Penetrating Wound Spx Chest

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.51 / $602.71 / $602.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.52 / $490.28 / $915.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.04 / $566.79 / $1,593.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.49 / $542.75 / $1,154.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$429.30 / $1,018.60 / $4,557.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.74 / $716.63 / $1,392.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$422.00 / $662.79 / $1,285.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.30 / $677.81 / $1,075.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.57 / $858.19 / $1,334.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.20 / $497.00 / $1,305.00