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Oasis Burn Matrix

Florida 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 $126 · 10th–90th $13$645,6540%20%40%10th90th$126Professionalmedian $13 · 10th–90th $13$1260%50%90th$13$1.0$10.0$100.0$1.0K$10.0K$100.0K$1.0M

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
$12.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$13.80
AvMed
Setting
Facility
Modifier
Global
Typical Low
$12.88
Median
$107.15
Typical High
$125.89
AvMed
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$97.72
Typical High
$131.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$190.55
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$426,579.52
Typical High
$891,250.94
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$5.13
Median
$85.11
Typical High
$131.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$15.14
Median
$125.89
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$15.85
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$128.82