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South Dakota rates for HCPCS Q4226

MyOwn Skin, includes harvesting and preparation procedures, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,440.00 / $1,440.00 / $1,440.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,224.00 / $1,440.00 / $1,440.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.04 / $525.04 / $656.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.79 / $397.73 / $492.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.49 / $1,995.55 / $2,433.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $5,472.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$531.51 / $595.97 / $595.97
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.44 / $531.51 / $595.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,200.00 / $1,200.00 / $1,631.52