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MemoDerm, DermaSpan, TranZgraft or InteguPly

South Dakota rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated July 2026.

How much does MemoDerm, DermaSpan, TranZgraft or InteguPly cost?

$64.57

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $64.57 for this service. The price depends on where it is billed: about $64.57 from a physician practice, and about $63.10 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$64.57$63.10 to $83.18
FacilityA hospital or hospital-owned outpatient department$63.10$63.10 to $100

How much rates vary

Facilitymedian $63 · 10th to 90th $63 to $107Professionalmedian $65 · 10th to 90th $63 to $117
$100$200facility $63professional $65

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$97.72
Typical High
$97.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$77.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$107.15
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$72.44
Typical High
$81.28
Medica
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$100.00
Typical High
$120.23
Medica
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$331.13
Midlands
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$75.86
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$204.17
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$83.18
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$239.88
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10

Where South Dakota sits

The same service costs 2.0 times more in Alaska than in Arkansas. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 25th of 51

$64.57

AK $126AR $63.10

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.