go back

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
$1,152.00 / $1,152.00 / $1,440.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.00 / $864.00 / $1,080.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.00 / $960.00 / $960.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,144.80 / $1,144.80 / $2,170.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,144.80 / $1,144.80 / $1,144.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$928.00 / $928.00 / $928.00