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South Dakota rates for HCPCS Q4139

Amniomatrix Or Biodmatrix Injectable 1 Cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $640.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.00 / $640.00 / $987.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$915.20 / $1,668.91 / $1,975.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,146.04 / $1,146.04 / $1,146.04