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South Dakota rates for HCPCS Q4135

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $25.70 / $25.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $64.57
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
$37.15 / $43.65 / $109.65
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