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South Dakota rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,950 · 10th–90th $1,950–$3,3110%50%90th$1,950Professionalmedian $1,950 · 10th–90th $1,950–$2,4550%50%90th$1,950$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$1,949.84 / $1,949.84 / $1,949.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $2,754.23 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,041.74 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $3,311.31 / $3,548.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $6,760.83
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,344.23 / $2,398.83
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
$2,041.74 / $2,041.74 / $2,041.74
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
$1,949.84 / $1,949.84 / $1,949.84
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $1,949.84 / $1,949.84