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Oasis Burn Matrix

Missouri 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 $16 · 10th–90th $13$2090%20%10th90th$16Professionalmedian $15 · 10th–90th $13$1320%20%40%10th90th$15$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$12.88
Typical High
$15.85
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$23.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$97.72
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$15.14
Typical High
$40.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$12.30
Typical High
$6,165.95
United
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$102.33
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$15.85
Median
$125.89
Typical High
$125.89