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Oasis Burn Matrix

Alaska rates for HCPCS Q4103

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

Rates data updated July 2026.

Facilitymedian $17 · 10th–90th $12$1780%20%10th90th$17Professionalmedian $58 · 10th–90th $13$4070%20%10th90th$58$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
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$23.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$10.47
Median
$13.80
Typical High
$33.11
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$302.00
Typical High
$489.78
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$20.89
Typical High
$38.02
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$16.60
Typical High
$18.20
Providence
Setting
Facility
Modifier
Global
Typical Low
$11.75
Median
$16.60
Typical High
$302.00
Providence
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$190.55
Typical High
$389.05