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South Dakota rates for HCPCS Q0112

All potassium hydroxide (KOH) preparations

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $6.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $5.01 / $7.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $8.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $6.61 / $85.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $4.68 / $7.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $9.77 / $9.77
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $13.49 / $15.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $4.68 / $7.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $5.89 / $5.89