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South Carolina rates for HCPCS Q4103

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

Facilitymedian $17 · 10th–90th $13–$1510%20%10th90th$17Professionalmedian $12 · 10th–90th $12–$1150%50%90th$12$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
$12.88 / $17.38 / $93.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.88
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $117.49 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $181.97 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6.76 / $13.18 / $28.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $30.20 / $85.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.89 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $125.89 / $125.89