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South Dakota rates for HCPCS Q4197

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

Facilitymedian $71 · 10th–90th $71–$1290%50%90th$71Professionalmedian $71 · 10th–90th $71–$2570%50%90th$71$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
$70.79 / $70.79 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $162.18 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $85.11 / $93.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $120.23 / $302.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $457.09
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $89.13
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $204.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $257.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79