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Kentucky rates for HCPCS Q4103

Oasis Burn Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $17.48 / $19.98
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $13.74 / $19.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.69 / $12.49 / $17.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.87 / $16.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $13.38