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Indiana rates for HCPCS Q4103

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

Facilitymedian $245 · 10th–90th $13–$5130%10%10th90th$245Professionalmedian $12 · 10th–90th $12–$320%50%90th$12$2.0$10.0$50.0$200.0

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 / $12.59
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $263.03 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $21.38
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $15.14 / $22.39
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $346.74 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $125.89 / $125.89