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Nevada 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
$12.38 / $12.38 / $13.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $13.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $12.49 / $12.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $127.38 / $222.92
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.38 / $127.38 / $127.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49