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South Dakota rates for HCPCS Q4156

Neox 100 or Clarix 100, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.88 / $65.88 / $65.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $65.88 / $65.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.95 / $89.95 / $112.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.95 / $66.62 / $82.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.34 / $112.13 / $240.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $66.34 / $3,978.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.70 / $83.26 / $96.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.70 / $79.62 / $180.15
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.09 / $72.09 / $72.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.05 / $65.88 / $84.55
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.34 / $66.34 / $66.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.34 / $66.34 / $66.34