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Oasis Burn Matrix

Georgia 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 $135 · 10th–90th $13$3390%20%40%10th90th$135Professionalmedian $13 · 10th–90th $13$1070%50%10th90th$13$2.0$10.0$50.0$200.0

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
$15.14
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$15.49
Typical High
$15.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$234.42
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$128.82
Typical High
$186.21
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$245.47
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$16.60
Median
$125.89
Typical High
$128.82