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South Dakota rates for HCPCS Q4225

AmnioBind or DermaBind TL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,427.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,427.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $2,088.00 / $2,610.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,692.08 / $1,692.08 / $2,115.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,370.73 / $2,316.53 / $2,386.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.73 / $1,370.73 / $6,612.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,644.88 / $1,897.42 / $2,189.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,644.88 / $1,644.88 / $1,664.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,562.11 / $1,562.11 / $1,562.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,427.45 / $1,427.45 / $1,926.61
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,370.73 / $1,370.73 / $1,370.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,370.73 / $1,370.73 / $1,370.73