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South Dakota rates for HCPCS Q4175

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.00 / $89.00 / $111.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.86 / $75.44 / $87.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.72 / $114.45 / $160.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.72 / $67.72 / $304.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.26 / $89.76 / $103.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.12 / $81.26 / $87.57
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.18 / $100.18 / $100.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.81 / $91.54 / $100.69
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.72 / $67.72 / $67.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.72 / $67.72 / $67.72