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South Dakota rates for HCPCS Q4229

Cogenex Amniotic Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.36 / $461.36 / $461.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.36 / $461.36 / $553.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.15 / $1,272.15 / $1,590.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.01 / $516.12 / $638.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.31 / $558.22 / $905.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.31 / $330.31 / $3,610.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.79 / $677.34 / $781.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.79 / $396.37 / $601.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.88 / $504.88 / $504.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.36 / $461.36 / $507.50
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$330.31 / $330.31 / $330.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$330.31 / $330.31 / $330.31