go back

South Dakota rates for HCPCS Q4115

Alloskin Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.41 / $18.45 / $23.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.60 / $12.86 / $15.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.48 / $24.47 / $25.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $14.48 / $66.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.05 / $17.27 / $22.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.05 / $14.86 / $17.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.07 / $14.07 / $14.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $18.00
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.48 / $14.48 / $14.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.48 / $14.48 / $14.48