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South Dakota rates for HCPCS Q4122

Dermacell Dermacell Awm Or Dermacell Awm Porous Per Square Centimeter (Desc Rvsd 10/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.00 / $121.00 / $121.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $121.00 / $121.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.84 / $142.84 / $142.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.93 / $163.59 / $204.49
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $459.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.11 / $132.11 / $132.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $149.56
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.00 / $110.00 / $110.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $110.00