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Matrion

South Dakota rates for HCPCS Q4201

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

Rates data updated July 2026.

Facilitymedian $76 · 10th–90th $76$1700%50%90th$76Professionalmedian $87 · 10th–90th $76$2880%20%10th90th$87$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
$75.86
Median
$75.86
Typical High
$75.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$147.91
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$95.50
Typical High
$109.65
Medica
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$134.90
Typical High
$288.40
Medica
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$79.43
Typical High
$1,288.25
Midlands
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$104.71
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
$288.40
Median
$288.40
Typical High
$288.40
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$125.89
Typical High
$239.88
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86