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South Dakota rates for HCPCS 22101

Prtl Exc Pst Vrt Intrnsc B1y Les 1 Vrt Sgm Thrc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$846.88 / $846.88 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.16 / $846.88 / $1,412.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.83 / $1,956.32 / $2,445.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,035.95 / $1,311.26 / $2,150.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.39 / $1,714.19 / $6,395.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,257.28 / $1,956.28 / $2,662.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.28 / $1,798.95 / $2,330.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.91 / $1,403.37 / $1,768.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,357.00 / $5,357.00 / $5,357.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.91 / $1,510.12 / $2,333.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,754.50 / $2,146.69 / $2,146.69