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Oasis Burn Matrix

South Dakota rates for HCPCS Q4103

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

Rates data updated October 2026.

How much does Oasis Burn Matrix cost?

$13.49

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $13.49 for this service. The price depends on where it is billed: about $13.49 from a physician practice, and about $12.59 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$13.49$12.59 to $15.85
FacilityA hospital or hospital-owned outpatient department$12.59$12.59 to $17.78

How much rates vary

Facilitymedian $13 · 10th to 90th $13 to $21Professionalmedian $13 · 10th to 90th $12 to $126
$10$100$1Kfacility $13professional $13

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Aetna
Setting
Professional
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$12.88
Cigna
Setting
Facility
Modifier
None
Typical Low
$13.18
Median
$16.98
Typical High
$169.82
Cigna
Setting
Professional
Modifier
None
Typical Low
$12.88
Median
$14.79
Typical High
$15.85
Medica
Setting
Facility
Modifier
None
Typical Low
$15.14
Median
$20.89
Typical High
$20.89
Medica
Setting
Professional
Modifier
None
Typical Low
$10.72
Median
$12.30
Typical High
$28.18
Midlands
Setting
Professional
Modifier
None
Typical Low
$14.79
Median
$14.79
Typical High
$14.79
Midlands
Setting
Facility
Modifier
None
Typical Low
$13.18
Median
$13.18
Typical High
$204.17
Midlands
Setting
Professional
Modifier
None
Typical Low
$11.48
Median
$11.48
Typical High
$11.48
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$14.13
Median
$14.13
Typical High
$14.13
United
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$125.89
Typical High
$141.25
Wellmark
Setting
Facility
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Wellmark
Setting
Professional
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$12.59

Where South Dakota sits

The same service costs 10.0 times more in Oregon than in Virginia. 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· 40th of 51

$13.49

OR $126VA $12.59

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.