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New Mexico rates for HCPCS Q4103

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

Facilitymedian $26 · 10th–90th $9–$1200%10%20%10th90th$26Professionalmedian $12 · 10th–90th $12–$1170%50%90th$12$2.0$20.0$200.0$2.0K$20.0K

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
$12.02 / $12.02 / $12.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $15.14
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $30.90 / $50.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $18.62 / $60.26
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.68 / $12.88 / $125.89
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $16.22
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $125.89 / $125.89