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Virginia rates for HCPCS Q4103

Oasis Burn Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $13.12 / $13.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $13.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $16.73
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.24 / $10.24 / $16.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $11.78 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.62 / $12.49 / $14.57
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.87 / $19.98
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $19.29 / $31.18
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.38 / $14.25 / $18.57
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.38 / $14.25 / $18.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $14.19