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Michigan rates for HCPCS Q4103

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

Facilitymedian $12 · 10th–90th $12–$1020%20%40%90th$12Professionalmedian $12 · 10th–90th $12–$210%50%10th90th$12$2.0$5.0$10.0$20.0$50.0$100.0$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 / $12.02 / $12.02
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
$2.34 / $7.41 / $11.75
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.92 / $11.75 / $11.75
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.57 / $4.57 / $125.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.60 / $18.62 / $46.77
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $17.38 / $138.04
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.57 / $4.57 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $125.89 / $125.89