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South Dakota rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.20 / $44.94 / $44.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.05 / $67.50 / $76.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $45.79 / $57.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $60.77 / $75.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $1,816.40
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.99 / $43.34 / $69.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.99 / $43.34 / $53.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $58.58