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Montana rates for HCPCS Q4103

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

Facilitymedian $13 · 10th–90th $13–$250%20%40%10th90th$13Professionalmedian $12 · 10th–90th $12–$1170%50%90th$12$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
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $14.45 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $125.89 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $13.49 / $25.12
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $13.49 / $25.12
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.94 / $14.13 / $169.82
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $79.43 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89