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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
$50.12 / $50.12 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $50.12 / $63.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $79.43 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $69.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $75.86 / $114.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $45.71 / $229.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $54.95 / $66.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $204.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $97.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $125.89 / $173.78
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $51.29 / $51.29