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South Dakota rates for HCPCS Q4185

Cellesta Flowable Amnion (25 mg per cc); per 0.5 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.62 / $588.62 / $588.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.62 / $588.62 / $1,646.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.33 / $781.33 / $781.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$994.77 / $2,781.79 / $3,292.06
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,475.42 / $1,475.42 / $1,475.42