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South Dakota rates for HCPCS Q4111

Gammagraft Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.85 / $11.58 / $12.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.46 / $8.40 / $9.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $12.03 / $12.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $7.12 / $32.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.53 / $9.52 / $10.99
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.36 / $8.53 / $10.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.61 / $8.61 / $8.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.66
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $7.12 / $7.12
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $7.12 / $7.12