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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
$457.09 / $457.09 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $1,258.93 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $645.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$331.13 / $562.34 / $1,412.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $3,630.78
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $602.56
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
$1,412.54 / $1,412.54 / $1,412.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $275.42 / $1,659.59
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09