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South Dakota rates for HCPCS 96910

Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.57 / $133.57 / $133.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.42 / $106.46 / $202.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.34 / $250.55 / $313.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.80 / $169.71 / $265.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.30 / $210.49 / $758.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.00 / $176.10 / $282.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $160.13 / $280.75
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.24 / $142.28 / $227.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.11 / $192.87 / $261.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.80 / $206.80 / $215.10