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Minnesota rates for HCPCS Q4103

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

Facilitymedian $19 · 10th–90th $12–$440%20%10th90th$19Professionalmedian $102 · 10th–90th $11–$1260%20%10th90th$102$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$12.59 / $18.62 / $20.42
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.72 / $107.15 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$18.20 / $37.15 / $52.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.14 / $16.22
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.05 / $38.02 / $47.86
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $14.45
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $26.92
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $16.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $125.89 / $239.88