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South Dakota rates for HCPCS Q4165

Keramatrix Or Kerasorb Per Square Centimeter (Desc Rvsd 10/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.24 / $53.24 / $53.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $53.24 / $53.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.24 / $74.68 / $89.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $136.72
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $36.00 / $36.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.58 / $30.58 / $30.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $48.80
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.98 / $29.98 / $29.98
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.98 / $29.98 / $29.98