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Oasis Burn Matrix

Nebraska 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 $14 · 10th–90th $12$2090%20%10th90th$14Professionalmedian $13 · 10th–90th $13$310%50%10th90th$13$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
$20.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$13.49
Typical High
$14.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$13.49
Typical High
$14.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$13.80
Median
$190.55
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$15.14
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$17.78
Typical High
$24.55
Medica
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$16.22
Midlands
Setting
Professional
Modifier
Global
Typical Low
$14.13
Median
$14.79
Typical High
$18.62
Midlands
Setting
Facility
Modifier
Global
Typical Low
$9.12
Median
$204.17
Typical High
$309.03
Midlands
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$18.62
Typical High
$30.90
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$134.90
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$16.22
Median
$125.89
Typical High
$141.25