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Arizona rates for HCPCS Q4103

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.74 / $24.98 / $24.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.62 / $13.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.10 / $23.87 / $59.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.26 / $12.63 / $29.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $12.49 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.58 / $13.73 / $27.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $12.38 / $36.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49