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South Dakota rates for HCPCS Q4196

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

Facilitymedian $100 · 10th–90th $100$1700%50%90th$100Professionalmedian $100 · 10th–90th $100$1740%50%90th$100$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
$100.00 / $100.00 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $125.89
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $107.15 / $112.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $144.54 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $117.49 / $134.90
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $165.96 / $204.17
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $467.74
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $125.89
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $169.82 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $131.83
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
$100.00 / $100.00 / $100.00
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00