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South Dakota rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $78 · 10th–90th $78–$1450%50%90th$78Professionalmedian $78 · 10th–90th $78–$1050%50%90th$78$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
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $144.54 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $100.00 / $104.71
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $144.54 / $169.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $85.11 / $380.19
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $102.33 / $102.33
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $204.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $77.62
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $77.62