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South Dakota rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.10 / $106.80 / $131.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.08 / $102.08 / $127.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.92 / $182.38 / $206.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.17 / $107.92 / $784.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.11 / $129.50 / $267.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.54 / $123.72 / $129.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.18 / $107.18 / $107.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $107.73
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.92 / $107.92 / $107.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.92 / $107.92 / $107.92