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South Dakota rates for HCPCS 96912

Photochemotx Psoralens&Ultraviolet Puva

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.46 / $114.07 / $134.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.79 / $212.16 / $265.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.38 / $184.76 / $650.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $181.94 / $238.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.00 / $152.19 / $192.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.38 / $181.48 / $282.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.19 / $175.60 / $182.60