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South Dakota rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $15,404.40 / $54,325.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.44 / $31.11 / $31.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.50 / $53.13 / $53.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.88 / $31.88 / $39.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.11 / $47.32 / $58.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $34.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.72 / $37.72 / $46.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.72 / $39.22 / $40.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.11 / $31.11 / $34.22