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South Dakota rates for HCPCS Q4108

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

Facilitymedian $39 · 10th–90th $38–$830%50%10th90th$39Professionalmedian $48 · 10th–90th $38–$740%20%40%10th90th$48$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
$38.02 / $38.02 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $64.57
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $63.10 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $58.88 / $64.57
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $75.86 / $87.10
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $48.98 / $199.53
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $58.88 / $60.26
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $169.82 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $102.33
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $38.90
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $38.90