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South Dakota rates for HCPCS Q4107

Graftjacket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.13 / $101.13 / $101.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $101.13 / $101.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.50 / $153.13 / $163.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.88 / $105.78 / $114.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.59 / $153.82 / $170.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $844.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.78 / $124.01 / $167.39
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.78 / $116.64 / $136.19
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.95 / $85.95 / $85.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $150.12
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.01 / $91.01 / $91.01
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.01 / $91.01 / $91.01