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South Dakota rates for HCPCS Q4169

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,068.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,068.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.15 / $239.15 / $298.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.36 / $224.20 / $227.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,220.57 / $3,752.76 / $3,865.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,220.57 / $2,220.57 / $11,634.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.12 / $271.48 / $2,664.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.68 / $474.39 / $2,664.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,263.61 / $2,263.61 / $2,263.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,275.32
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,220.57 / $2,220.57 / $2,220.57
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,220.57 / $2,220.57 / $2,220.57