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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 October 2026.

How much does Oasis Burn Matrix cost?

$126

Typical negotiated rate. In Illinois, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $195 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$12.59 to $126
FacilityA hospital or hospital-owned outpatient department$195$151 to $251

How much rates vary

Facilitymedian $195 · 10th to 90th $23 to $282Professionalmedian $126 · 10th to 90th $13 to $132
$20$50$100$200facility $195professional $126

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$117.49
Aetna
Setting
Professional
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$12.88
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$15.14
Median
$181.97
Typical High
$257.04
Cigna
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$239.88
Typical High
$302.00
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Hally Health
Setting
Professional
Modifier
None
Typical Low
$10.72
Median
$15.14
Typical High
$39.81
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
None
Typical Low
$16.22
Median
$16.22
Typical High
$16.22
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$144.54

Where Illinois sits

The same service costs 10.0 times more in Oregon than in Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Illinois· 18th of 51

$126

OR $126VA $12.59

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.