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South Dakota rates for HCPCS A2009

Symphony, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.20 / $62.20 / $62.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.20 / $62.20 / $102.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.13 / $93.13 / $93.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.09 / $172.38 / $279.48
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.30 / $91.30 / $383.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.30 / $91.30 / $100.43