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Nebraska rates for HCPCS Q4103

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

Facilitymedian $13 · 10th–90th $12–$1910%20%10th90th$13Professionalmedian $12 · 10th–90th $12–$210%50%90th$12$10.0$50.0$200.0$1.0K$5.0K

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
$12.59 / $12.59 / $12.59
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $20.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10.72 / $13.49 / $14.13
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $13.49 / $14.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.80 / $190.55 / $229.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.85 / $125.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $17.78 / $24.55
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $16.22
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.79 / $18.62
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.12 / $204.17 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $18.62 / $30.90
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $16.22
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $20.89 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $120.23 / $125.89