go back

New Hampshire rates for HCPCS Q4103

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

Facilitymedian $15 · 10th–90th $4–$2510%20%10th90th$15Professionalmedian $13 · 10th–90th $12–$240%50%10th90th$13$2.0$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
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $15.14 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $15.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.88 / $14.45
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $251.19 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $22.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.45 / $12.59 / $125.89
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.39 / $3.55 / $18.20