go back

South Dakota rates for HCPCS Q4235

AMNIOREPAIR or AltiPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $87.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.25 / $185.25 / $231.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.71 / $97.68 / $120.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.48 / $136.01 / $147.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.48 / $80.48 / $558.10
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.58 / $123.69 / $202.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.58 / $113.91 / $202.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.28 / $96.28 / $96.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.98 / $87.98 / $96.78
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.48 / $80.48 / $80.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.48 / $80.48 / $80.48