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Zenith Amniotic Membrane

South Dakota rates for HCPCS Q4253

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

Rates data updated July 2026.

How much does Zenith Amniotic Membrane cost?

$75.86

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $75.86 from a physician practice, and about $75.86 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$75.86$75.86 to $100
FacilityA hospital or hospital-owned outpatient department$75.86$75.86 to $141

How much rates vary

Facilitymedian $76 · 10th to 90th $76 to $170Professionalmedian $76 · 10th to 90th $72 to $977
$100$200$500$1Kfacility $76professional $76

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$120.23
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$91.20
Typical High
$91.20
Medica
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$141.25
Typical High
$977.24
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$83.18
Typical High
$1,318.26
Midlands
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$100.00
Typical High
$100.00
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$204.17
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$977.24
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$239.88
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86

Where South Dakota sits

The same service costs 2.5 times more in Alaska than in Maryland. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

South Dakota· 45th of 51

$75.86

AK $191MD $75.86

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.