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South Dakota rates for HCPCS Q4123

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

Facilitymedian $71 · 10th–90th $71–$1200%50%90th$71Professionalmedian $71 · 10th–90th $48–$1200%50%10th90th$71$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
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $100.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $51.29 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $47.86 / $47.86
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $120.23 / $128.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $398.11
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $85.11
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $169.82 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $69.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79