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Idaho rates for HCPCS Q4103

Oasis Burn Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.38 / $12.38 / $12.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $13.74 / $15.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $12.49 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.76 / $13.74 / $17.59
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.74 / $15.61
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.42 / $24.43 / $55.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.99 / $14.99 / $14.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49