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South Dakota rates for HCPCS A2015

Phoenix wound matrix, per square centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.34 / $76.34 / $76.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.34 / $76.34 / $665.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.24 / $785.24 / $1,385.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.03 / $1,124.66 / $1,823.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.66 / $1,438.66 / $4,904.35
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.74 / $1,385.73 / $2,192.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $1,385.73 / $1,385.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,438.66 / $1,438.66 / $1,582.53