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Oasis Burn Matrix

Illinois 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 $178 · 10th–90th $13$2570%10%10th90th$178Professionalmedian $13 · 10th–90th $13$1260%50%90th$13$5.0$10.0$20.0$50.0$100.0$200.0$500.0

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
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$13.80
BCBS
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$194.98
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$194.98
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$125.89
Typical High
$125.89
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$19.05
Typical High
$39.81
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$16.22
Typical High
$16.22
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$125.89
Typical High
$125.89