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North Carolina 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
$6.01 / $12.94 / $17,381.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.94 / $13.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.74 / $5.74 / $11.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $8.76 / $9.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $12.49 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $15.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.34 / $12.94 / $19.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $4.38 / $16.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $15.70 / $17.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $16.23
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $100.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,184.50 / $6,184.50 / $6,184.50