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South Dakota rates for HCPCS Q4253

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

Facilitymedian $76 · 10th–90th $76–$1660%50%90th$76Professionalmedian $76 · 10th–90th $76–$8510%50%90th$76$100.0$200.0$500.0$1.0K

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
$75.86 / $75.86 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $194.98 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $85.11 / $91.20
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $141.25 / $977.24
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $83.18 / $1,318.26
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $100.00 / $100.00
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
$977.24 / $977.24 / $977.24
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
$75.86 / $75.86 / $75.86
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $75.86