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South Dakota rates for HCPCS Q4153

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.00 / $210.00 / $262.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.50 / $130.50 / $163.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.60 / $183.53 / $194.55
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.60 / $108.60 / $1,027.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.32 / $265.29 / $349.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.32 / $153.69 / $265.29
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.94 / $150.94 / $150.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $151.72
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.60 / $108.60 / $108.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.60 / $108.60 / $108.60