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South Dakota rates for HCPCS Q4104

Integra bilayer matrix wound dressing (BMWD), per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $51 · 10th–90th $51$910%50%90th$51Professionalmedian $51 · 10th–90th $51$850%50%90th$51$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $81.28
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $51.29 / $52.48
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $67.61 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $60.26 / $63.10
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $81.28 / $95.50
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $53.70 / $229.09
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $64.57 / $64.57
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $169.82 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $100.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $69.18 / $69.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29