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South Dakota rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$981.75 / $981.75 / $1,227.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.85 / $487.59 / $502.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $824.03 / $980.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $2,386.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.63 / $519.96 / $591.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.96 / $585.10 / $591.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.59 / $533.59 / $533.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $536.35
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59