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Virginia rates for HCPCS Q4103

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

Facilitymedian $13 · 10th–90th $12$450%20%10th90th$13Professionalmedian $12 · 10th–90th $12$410%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
$12.02 / $12.02 / $12.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $15.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $22.39
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.23 / $10.23 / $19.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $131.83 / $239.88
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.37 / $4.37 / $4.37
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $13.18 / $22.91
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $109.65
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.75 / $14.13 / $18.20
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $14.13 / $18.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $20.89 / $26.92
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $125.89 / $125.89