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Oasis Burn Matrix

New York 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$1740%50%90th$13Professionalmedian $13 · 10th–90th $12$420%50%10th90th$13$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$13.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$10.72
Median
$10.72
Typical High
$10.72
Cigna
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$165.96
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$14.13
Median
$138.04
Typical High
$338.84
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$162.18
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.88
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.88
Typical High
$12.88
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$15.85
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$15.85
Typical High
$23.44
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.59
Typical High
$125.89
Univera
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$13.80
Univera
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.88
Typical High
$12.88