go back

Oasis Burn Matrix

Michigan 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 $17 · 10th–90th $13$1020%20%40%10th90th$17Professionalmedian $13 · 10th–90th $12$1260%50%10th90th$13$2.0$5.0$10.0$20.0$50.0$100.0$200.0

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
$12.88
Median
$12.88
Typical High
$12.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$13.18
BCBS
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$79.43
Typical High
$125.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$125.89
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$4.57
Median
$4.57
Typical High
$125.89
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$16.60
Median
$18.62
Typical High
$46.77
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$17.38
Typical High
$138.04
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$4.57
Median
$4.57
Typical High
$4.57
United
Setting
Facility
Modifier
Global
Typical Low
$16.22
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$125.89
Typical High
$125.89