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South Dakota rates for HCPCS Q4102

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

Facilitymedian $12 · 10th–90th $11$200%50%10th90th$12Professionalmedian $12 · 10th–90th $11$200%20%40%10th90th$12$10.0$20.0$50.0$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
$10.96 / $10.96 / $13.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $10.96 / $16.22
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.02 / $12.59 / $12.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $16.60 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $14.13 / $15.14
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.75 / $19.95 / $23.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $1,584.89
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $14.45
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $169.82 / $204.17
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $24.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.49 / $13.49 / $13.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $11.75
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $11.75