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South Dakota rates for HCPCS Q4115

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

Facilitymedian $13 · 10th–90th $12–$250%50%10th90th$13Professionalmedian $13 · 10th–90th $12–$210%20%40%10th90th$13$10.0$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
$12.02 / $12.02 / $12.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $19.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.49 / $18.62 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $14.79 / $15.85
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $24.55 / $28.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $14.45 / $67.61
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $17.38 / $17.38
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.49 / $169.82 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $22.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88