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South Dakota rates for HCPCS Q4121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.75 / $52.75 / $52.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $52.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.50 / $59.40 / $83.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.76 / $53.29 / $65.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.85 / $82.56 / $85.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.85 / $48.85 / $213.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.24 / $62.14 / $72.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.87 / $57.05 / $62.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.73 / $57.73 / $57.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $58.03
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.85 / $48.85 / $48.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.85 / $48.85 / $48.85