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South Dakota rates for HCPCS Q4133

Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $138 · 10th–90th $138–$2340%50%90th$138Professionalmedian $138 · 10th–90th $138–$2400%50%90th$138$100.0$200.0$500.0$1.0K

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
$138.04 / $138.04 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $275.42
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $138.04 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $204.17 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $173.78
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $229.09 / $281.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $1,445.44
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $162.18
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $204.17 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $239.88
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
$138.04 / $138.04 / $138.04
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $138.04