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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
$138.04 / $138.04 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $208.93 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $162.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $181.97 / $194.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $1,023.29
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $154.88
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
$218.78 / $218.78 / $218.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $239.88 / $302.00
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04