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South Dakota rates for HCPCS Q4203

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

Facilitymedian $1,047 · 10th–90th $871–$1,4790%50%10th90th$1,047Professionalmedian $1,047 · 10th–90th $309–$1,1480%50%10th90th$1,047$100.0$200.0$500.0$1.0K$2.0K

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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $407.38 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $380.19
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $1,479.11 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $870.96 / $1,318.26
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $1,047.13 / $1,047.13
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
$851.14 / $851.14 / $851.14
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $295.12
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13