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Mississippi 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
$13.12 / $13.12 / $14.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $13.12 / $14.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.32 / $5.32 / $5.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.32 / $5.32 / $5.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.87 / $12.49 / $16.23