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South Dakota rates for HCPCS Q4148

Neox Cord 1k Neox Cord Rt Or Clarix Cord 1k Persquare Centimeter (Desc Revised 1/1/2018)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.80 / $123.80 / $123.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.80 / $123.80 / $135.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.05 / $176.05 / $220.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.84 / $132.15 / $163.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.06 / $213.04 / $354.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.06 / $126.06 / $3,125.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.28 / $165.76 / $191.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.28 / $151.28 / $281.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.47 / $135.47 / $135.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.80 / $123.80 / $136.18
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.06 / $126.06 / $126.06
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.06 / $126.06 / $126.06