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South Dakota rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $1,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,200.00 / $1,200.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,200.00 / $1,662.96 / $2,028.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $4,560.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$849.99 / $849.99 / $849.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $867.89
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.99 / $899.99 / $899.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.99 / $899.99 / $899.99