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South Dakota rates for HCPCS Q4178

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.41 / $89.41 / $89.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $89.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.19 / $137.19 / $171.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.79 / $94.73 / $117.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.11 / $157.36 / $225.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.03 / $93.11 / $436.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.44 / $113.33 / $130.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.44 / $111.73 / $270.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.85 / $97.85 / $97.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.41 / $89.41 / $100.26
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.11 / $93.11 / $93.11
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.11 / $93.11 / $93.11