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South Dakota rates for HCPCS Q4195

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

Facilitymedian $98 · 10th–90th $98–$1820%50%90th$98Professionalmedian $102 · 10th–90th $98–$1740%20%40%10th90th$102$100.0$200.0$500.0

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
$97.72 / $97.72 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $107.15 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $123.03 / $128.82
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $181.97 / $204.17
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $107.15 / $776.25
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $128.82 / $128.82
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $169.82 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $123.03 / $123.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $173.78
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
$97.72 / $97.72 / $97.72
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $97.72