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South Dakota rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $3 · 10th–90th $2–$150%50%10th90th$3Professionalmedian $2 · 10th–90th $2–$150%50%90th$2$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$2.00 / $2.00 / $15.14
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $15.14
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $15.49 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $11.48
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.45 / $4.17 / $15.14
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.45 / $2.45 / $5,370.32
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.95 / $2.95 / $10.96
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.20 / $169.82 / $204.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $125.89 / $239.88
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $2.51 / $2.51
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $2.51 / $2.51