go back

Oasis Burn Matrix

California 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 $16 · 10th–90th $13$740%20%40%10th90th$16Professionalmedian $13 · 10th–90th $5$1380%20%40%10th90th$13$0.1$2.0$50.0$1.0K$20.0K$500.0K

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
Facility
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$57.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$57.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$16.22
Typical High
$40.74
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$12.88
Typical High
$24.55
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$19.95
Typical High
$28.84
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$5.13
Typical High
$10.72
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$218.78
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$5.25
Typical High
$239.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$165.96
Typical High
$269.15
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$6,165.95
Median
$6,165.95
Typical High
$6,165.95
Molina
Setting
Professional
Modifier
Global
Typical Low
$4.79
Median
$12.59
Typical High
$60.26
Providence
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$17.38
Typical High
$223.87
Providence
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$125.89
Typical High
$125.89
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$6.46
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$41.69
Typical High
$41.69
United
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$125.89
Typical High
$147.91