go back

Hawaii 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
$12.49 / $12.49 / $12.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $14.98 / $14.98
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.60 / $19.07 / $21.94
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.74 / $14.99 / $17.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $13.48 / $18.73