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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
$1,412.54 / $1,412.54 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $2,089.30 / $2,630.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $2,137.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,041.74 / $2,454.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $6,606.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $204.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $275.42 / $1,445.44
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,412.54