go back

Alaska rates for HCPCS Q4103

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.24 / $23.24 / $23.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $17.68
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.38 / $23.24 / $32.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $16.89
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.98 / $24.00 / $38.22
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.19 / $16.50 / $18.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $23.24 / $33.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $15.13 / $18.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.73 / $18.73 / $37.47