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South Dakota rates for HCPCS Q4173

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.02 / $349.02 / $349.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $349.02 / $349.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.65 / $466.65 / $583.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.31 / $370.99 / $459.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.55 / $602.57 / $810.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.55 / $356.55 / $2,835.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.86 / $527.04 / $590.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.86 / $432.61 / $527.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.94 / $381.94 / $381.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $349.02 / $799.54
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.55 / $356.55 / $356.55
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.55 / $356.55 / $356.55