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Oasis Burn Matrix

Minnesota 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 $32 · 10th–90th $13$2570%10%20%10th90th$32Professionalmedian $102 · 10th–90th $11$1260%20%10th90th$102$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$13.80
BCBS
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$18.62
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$107.15
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$33.88
Typical High
$46.77
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$15.14
Typical High
$16.22
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$22.91
Median
$33.11
Typical High
$47.86
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$17.38
Medica
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$26.92
Medica
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$16.98
United
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$125.89
Typical High
$239.88