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South Dakota rates for HCPCS Q4130

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $181.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.55 / $25.12 / $85.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $177.83