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Arizona rates for HCPCS Q4103

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

Facilitymedian $22 · 10th–90th $12–$850%20%10th90th$22Professionalmedian $12 · 10th–90th $12–$1260%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
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $21.88 / $22.91
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $16.98
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.22 / $19.95 / $64.57
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $17.78 / $30.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $208.93 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.33 / $13.49 / $29.51
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $16.22
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.89 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $125.89 / $125.89