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South Dakota rates for HCPCS Q4110

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.41 / $65.41 / $65.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $65.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.45 / $88.85 / $111.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.20 / $66.64 / $83.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.26 / $110.54 / $111.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $360.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.34 / $78.48 / $98.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.49 / $59.34 / $78.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.56 / $71.56 / $71.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $71.95
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.41 / $65.41 / $65.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $65.41