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South Dakota rates for HCPCS Q4210

Axolotl Graft or Axolotl DualGraft, per sq cm

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,071.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $954.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $933.25