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Oregon rates for HCPCS Q4103

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

Facilitymedian $13 · 10th–90th $12–$210%50%10th90th$13Professionalmedian $14 · 10th–90th $12–$2570%20%10th90th$14$2.0$20.0$200.0$2.0K$20.0K$200.0K$2.0M

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 / $117.49 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $22.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$17.78 / $25.12 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $138.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $257.04 / $323.59
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.33 / $13.80 / $141.25
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.85 / $239.88 / $316.23
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $12.59 / $12.88
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.22 / $13.80 / $144.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.49 / $79.43 / $125.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89