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Oasis Burn Matrix

North Dakota 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 $12$210%50%10th90th$13Professionalmedian $13 · 10th–90th $11$160%50%10th90th$13$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
$12.59
Typical High
$12.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$23.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$10.00
Median
$11.48
Typical High
$14.45
Cigna
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$22.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$15.85
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$14.45
Typical High
$22.39
Medica
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$13.80
United
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$125.89
Typical High
$239.88