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South Dakota rates for HCPCS Q4125

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.91 / $138.91 / $138.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.74 / $138.91 / $138.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.18 / $188.18 / $188.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.74 / $233.80 / $234.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.74 / $50.74 / $50.74