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South Dakota rates for HCPCS Q4257

Relese, Per Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$915.09 / $915.09 / $915.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $915.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$763.30 / $763.30 / $954.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$504.26 / $630.33 / $633.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.66 / $1,103.00 / $1,668.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.66 / $652.66 / $3,610.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.92 / $731.58 / $1,268.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.92 / $783.20 / $783.20
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,001.42 / $1,001.42 / $1,001.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.09 / $915.09 / $1,006.60
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.66 / $652.66 / $652.66
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.66 / $652.66 / $652.66