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South Dakota rates for HCPCS Q4204

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

Facilitymedian $3,715 · 10th–90th $3,715–$6,3100%50%90th$3,715Professionalmedian $3,715 · 10th–90th $2,884–$4,0740%50%10th90th$3,715$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$3,715.35 / $3,715.35 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $4,570.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $4,073.80 / $5,128.61
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,019.95 / $3,801.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $6,309.57 / $6,760.83
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,235.94 / $3,801.89 / $12,882.50
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,548.13 / $4,570.88 / $4,570.88
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
$2,884.03 / $2,884.03 / $2,884.03
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
$3,715.35 / $3,715.35 / $3,715.35
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $3,715.35