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Oasis Burn Matrix

Iowa 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 $13 · 10th–90th $13$210%50%90th$13Professionalmedian $13 · 10th–90th $12$1260%50%10th90th$13$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$19.05
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$57.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$223.87
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$14.79
Typical High
$16.98
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$13.80
Typical High
$25.70
Medica
Setting
Facility
Modifier
Global
Typical Low
$8.71
Median
$15.14
Typical High
$21.88
Medica
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$21.38
Midlands
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$15.14
Typical High
$17.38
Midlands
Setting
Facility
Modifier
Global
Typical Low
$10.00
Median
$208.93
Typical High
$269.15
Midlands
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$10.00
Typical High
$18.62
United
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$114.82
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$134.90
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$9.77
Median
$12.59
Typical High
$12.59