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Colorado 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
$12.38 / $12.49 / $12.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $11.78 / $17.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.25 / $13.24 / $20.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.62 / $13.74 / $17.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49