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Illinois rates for HCPCS Q4103

Oasis Burn Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.51 / $12.49 / $15.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $13.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.00 / $22.42 / $151.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $14.73
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.62 / $15.86 / $30.57
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.23 / $16.23 / $16.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.04 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $13.69