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South Dakota rates for HCPCS Q4140

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.62 / $161.62 / $161.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.62 / $161.62 / $161.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.40 / $233.40 / $291.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.13 / $172.13 / $215.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.84 / $278.58 / $446.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.84 / $164.84 / $1,697.27
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.80 / $257.70 / $446.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.80 / $197.80 / $331.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.88 / $176.88 / $176.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.62 / $161.62 / $177.78
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.84 / $164.84 / $164.84
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.84 / $164.84 / $164.84