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Cygnus Matrix

South Dakota rates for HCPCS Q4199

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

Rates data updated July 2026.

Facilitymedian $112 · 10th–90th $112$4470%50%90th$112Professionalmedian $129 · 10th–90th $112$4270%20%10th90th$129$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
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$446.68
Typical High
$562.34
Cigna
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$426.58
Medica
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$218.78
Typical High
$478.63
Medica
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$1,621.81
Midlands
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$398.11
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$204.17
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20