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South Dakota rates for HCPCS Q4152

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.72 / $50.72 / $50.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.72 / $50.72 / $50.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.95 / $62.95 / $78.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.65 / $55.65 / $69.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.41 / $76.73 / $154.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.41 / $45.41 / $229.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.49 / $67.67 / $78.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.38 / $54.49 / $69.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.49 / $55.49 / $55.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.72 / $50.72 / $55.79
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.41 / $45.41 / $45.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.41 / $45.41 / $45.41