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South Dakota rates for HCPCS Q4258

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

Facilitymedian $89 · 10th–90th $89–$1410%50%90th$89Professionalmedian $89 · 10th–90th $83–$2400%50%10th90th$89$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
$89.13 / $89.13 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $112.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $114.82 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $87.10 / $91.20
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $138.04 / $1,412.54
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $83.18 / $1,659.59
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $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
$1,412.54 / $1,412.54 / $1,412.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13