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Iowa rates for HCPCS Q4103

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

Facilitymedian $13 · 10th–90th $13$150%50%90th$13Professionalmedian $12 · 10th–90th $12$580%50%90th$12$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$12.02 / $12.59 / $19.05
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $16.98
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.72 / $223.87 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.49 / $19.50
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.72 / $13.80 / $25.70
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.71 / $15.14 / $21.88
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $21.38
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.03 / $15.14 / $16.98
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.00 / $208.93 / $269.15
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.00 / $10.00 / $18.62
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.79 / $16.22
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $20.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $125.89 / $131.83
Wellmark
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $12.59
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $12.59