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Kansas rates for HCPCS Q4103

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.48 / $17.48 / $17.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.74 / $17.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $10.00 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $15.00 / $18.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $12.38 / $6,184.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $15.87