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South Dakota rates for HCPCS Q4217

WoundFix, BioWound, WoundFix Plus, BioWound Plus, WoundFix Xplus or BioWound Xplus, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.00 / $318.00 / $318.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $318.00 / $318.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$506.15 / $506.15 / $632.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.66 / $318.00 / $348.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.00 / $537.41 / $871.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $318.00 / $1,994.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$328.21 / $482.12 / $1,074.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.21 / $381.60 / $1,486.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.00 / $348.00 / $348.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $318.00 / $349.80
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.00 / $318.00 / $318.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $318.00 / $318.00