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South Dakota rates for HCPCS Q4143

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.92 / $33.92 / $33.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $33.92 / $33.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.10 / $46.10 / $57.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.58 / $34.92 / $43.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.92 / $57.32 / $67.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $33.92 / $112.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.70 / $40.81 / $45.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.67 / $40.70 / $40.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.11 / $37.11 / $37.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $33.92 / $37.31
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.92 / $33.92 / $33.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.92 / $33.92 / $33.92