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South Dakota rates for HCPCS Q4235

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

Facilitymedian $87 · 10th–90th $87$1410%50%90th$87Professionalmedian $87 · 10th–90th $87$1200%50%90th$87$100.0$200.0$500.0

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
$87.10 / $87.10 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $186.21 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $120.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $134.90 / $147.91
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $562.34
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $114.82
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $204.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10