go back

Oasis Burn Matrix

Montana 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$250%20%40%10th90th$13Professionalmedian $14 · 10th–90th $13$1260%50%10th90th$14$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
Professional
Modifier
Global
Typical Low
$12.59
Median
$13.80
Typical High
$15.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$14.45
Median
$14.45
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$125.89
Typical High
$125.89
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$13.49
Typical High
$25.12
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$13.49
Typical High
$25.12
Providence
Setting
Facility
Modifier
Global
Typical Low
$7.94
Median
$14.13
Typical High
$181.97
Providence
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$79.43
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89