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South Dakota rates for HCPCS Q4103

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

Facilitymedian $13 · 10th–90th $12$210%50%10th90th$13Professionalmedian $13 · 10th–90th $12$210%20%40%10th90th$13$5.0$20.0$100.0$500.0$2.0K

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
$12.02 / $12.02 / $12.59
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $20.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $16.98 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $14.79 / $15.85
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $20.89 / $24.55
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $6,165.95
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $14.79 / $15.14
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
$11.48 / $11.48 / $11.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $14.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $12.59
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $12.59