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South Dakota rates for HCPCS Q4151

Amnioband Or Guardian Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $134.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.20 / $190.20 / $237.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.05 / $163.77 / $173.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.19 / $231.85 / $375.90
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $137.19 / $633.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$163.77 / $186.44 / $215.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.49 / $164.63 / $191.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.61 / $147.61 / $147.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $148.38
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.19 / $137.19 / $137.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.19 / $137.19 / $137.19