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Georgia 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
$12.49 / $12.49 / $12.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $13.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $24.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $11.78 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $15.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.48 / $12.48 / $37.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.24 / $23.11 / $239.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $16.63