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Oasis Burn Matrix

Indiana 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?

$12.59

Typical negotiated rate. In Indiana, October 2026.

Insurers have agreed to pay about $12.59 for this service. The price depends on where it is billed: about $12.59 from a physician practice, and about $191 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$12.59$12.59 to $126
FacilityA hospital or hospital-owned outpatient department$191$141 to $275

How much rates vary

Facilitymedian $191 · 10th to 90th $115 to $417Professionalmedian $13 · 10th to 90th $13 to $126
$10$50$200$1Kfacility $191professional $13

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
$12.59
Aetna
Setting
Professional
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$181.97
Typical High
$501.19
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$117.49
CareSource
Setting
Facility
Modifier
None
Typical Low
$12.59
Median
$18.62
Typical High
$25.12
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$229.09
Typical High
$346.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$616.60
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$19.95
Median
$275.42
Typical High
$2,137.96
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None
Typical Low
$10.23
Median
$12.59
Typical High
$190.55
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$173.78

Where Indiana 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.

Indiana· 49th of 51

$12.59

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.