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South Dakota rates for HCPCS A2007

Restrata, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.00 / $242.00 / $242.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.70 / $242.00 / $242.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.81 / $205.70 / $205.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.00 / $335.36 / $408.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.00 / $220.00 / $961.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.68 / $120.81 / $191.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.68 / $120.81 / $120.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.70 / $205.70 / $205.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.00 / $220.00 / $242.00
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.00 / $220.00 / $220.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.00 / $220.00 / $220.00