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Illinois rates for HCPCS Q4103

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

Facilitymedian $170 · 10th–90th $12–$2570%10%10th90th$170Professionalmedian $12 · 10th–90th $12–$1170%50%90th$12$5.0$10.0$20.0$50.0$100.0$200.0$500.0

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 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $14.13
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $190.55 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $208.93 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $125.89 / $125.89
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.22 / $19.05 / $39.81
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.22 / $16.22 / $16.22
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.89 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $125.89 / $125.89