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Wisconsin rates for HCPCS Q4103

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

Facilitymedian $14 · 10th–90th $12–$1000%20%10th90th$14Professionalmedian $12 · 10th–90th $12–$1260%50%10th90th$12$2.0$10.0$50.0$200.0$1.0K$5.0K

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
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $28.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.98 / $31.62 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $125.89 / $223.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $27.54
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $15.85
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $12.88 / $75.86
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $25.70
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $50.12 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $13.80 / $13.80
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $13.18 / $21.38
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $223.87 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $85.11 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $14.13 / $6,165.95
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $380.19
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $20.89 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $29.51
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $125.89 / $134.90