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South Dakota rates for HCPCS Q4254

Novafix DL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.88 / $355.88 / $1,030.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.10 / $525.10 / $656.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.83 / $397.76 / $492.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.88 / $456.00 / $607.44
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $1,824.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.43 / $560.83 / $560.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.78 / $576.48 / $576.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $528.00