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South Dakota rates for HCPCS 26121

Fasct Palm W/Wo Z-Plasty Tissue Reargmt/Skn Grft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$605.70 / $605.70 / $605.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.15 / $603.90 / $980.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,061.14 / $1,381.34 / $1,726.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.79 / $1,023.63 / $1,552.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.87 / $1,166.02 / $6,307.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.88 / $1,488.26 / $3,711.03
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.84 / $1,311.77 / $1,614.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$733.69 / $1,009.00 / $1,198.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.79 / $1,062.22 / $1,652.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,188.50 / $1,454.20 / $1,454.20