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South Dakota rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $550 · 10th–90th $550–$4,7860%50%90th$550Professionalmedian $550 · 10th–90th $550–$1,4130%20%40%90th$550$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
$549.54 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $691.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $1,513.56 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,412.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $4,786.30 / $5,011.87
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $2,818.38 / $9,332.54
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,388.44 / $3,388.44 / $3,388.44
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
$1,318.26 / $1,318.26 / $1,318.26
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
$549.54 / $549.54 / $549.54
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54