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South Dakota rates for HCPCS Q4107

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

Facilitymedian $91 · 10th–90th $91–$1550%50%90th$91Professionalmedian $85 · 10th–90th $81–$1260%50%10th90th$85$100.0$200.0$500.0

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
$100.00 / $100.00 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $85.11 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $154.88 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $114.82 / $114.82
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $134.90 / $169.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $138.04 / $851.14
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $134.90 / $134.90
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $169.82 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $204.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20