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South Dakota rates for HCPCS Q4154

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.90 / $131.90 / $131.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $131.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.30 / $205.30 / $256.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.16 / $137.52 / $170.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.86 / $241.43 / $472.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.66 / $142.86 / $2,287.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.38 / $187.66 / $216.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.44 / $171.43 / $204.16
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.34 / $144.34 / $144.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $145.09
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.86 / $142.86 / $142.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.86 / $142.86 / $142.86