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South Dakota rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $796.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,169.65 / $1,169.65 / $1,462.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$732.94 / $732.94 / $916.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.78 / $1,213.05 / $1,249.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.78 / $717.78 / $3,800.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$861.33 / $1,288.38 / $2,233.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.33 / $863.24 / $1,200.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$726.23 / $726.23 / $726.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $729.99
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.78 / $717.78 / $717.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.78 / $717.78 / $717.78