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Alaska rates for HCPCS Q4103

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

Facilitymedian $17 · 10th–90th $12–$1450%20%10th90th$17Professionalmedian $12 · 10th–90th $12–$3020%50%90th$12$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
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $15.14
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.47 / $13.80 / $33.11
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $302.00 / $512.86
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.13 / $20.89 / $38.02
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $16.60 / $18.20
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.47 / $15.14 / $144.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $125.89 / $354.81