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Texas rates for HCPCS Q4103

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

Facilitymedian $13 · 10th–90th $3$3980%20%10th90th$13Professionalmedian $12 · 10th–90th $12$1260%50%90th$12$1.0$5.0$20.0$100.0$500.0$2.0K

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 / $12.88
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.55 / $3.89 / $7.41
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $302.00 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,165.95 / $6,165.95 / $6,165.95
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.08 / $12.59 / $112.20
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.88 / $218.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.30 / $32.36
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.13 / $14.79 / $16.22
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.41 / $12.59 / $144.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $20.89 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $125.89 / $125.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89