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Oasis Burn Matrix

Oregon 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$260%50%10th90th$13Professionalmedian $126 · 10th–90th $13$2750%20%10th90th$126$2.0$20.0$200.0$2.0K$20.0K$200.0K$2.0M

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
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$57.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$17.78
Median
$25.12
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$257.04
Typical High
$323.59
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$9.33
Median
$14.13
Typical High
$141.25
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$239.88
Typical High
$316.23
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$12.59
Typical High
$12.88
Providence
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$16.22
Typical High
$245.47
Providence
Setting
Professional
Modifier
Global
Typical Low
$15.49
Median
$79.43
Typical High
$125.89
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89