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Oasis Burn Matrix

Kentucky 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$1740%50%90th$13Professionalmedian $13 · 10th–90th $13$180%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
$12.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.59
Typical High
$12.59
CareSource
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$19.95
CareSource
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$13.49
Typical High
$17.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$173.78
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$125.89
Typical High
$616.60
Molina
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$17.38
United
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$16.22
Typical High
$102.33
United
Setting
Professional
Modifier
Global
Typical Low
$20.89
Median
$125.89
Typical High
$125.89