go back

Oasis Burn Matrix

Pennsylvania rates for HCPCS Q4103

Oasis burn matrix, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated October 2026.

How much does Oasis Burn Matrix cost?

$12.59

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $12.59 for this service. The price depends on where it is billed: about $12.59 from a physician practice, and about $166 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$12.59$12.59 to $126
FacilityA hospital or hospital-owned outpatient department$166$14.79 to $214

How much rates vary

Facilitymedian $166 · 10th to 90th $13 to $479Professionalmedian $13 · 10th to 90th $13 to $126
$10$100$1K$10Kfacility $166professional $13

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Aetna
Setting
Professional
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$10.96
Median
$12.59
Typical High
$5,011.87
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$11.22
Median
$12.59
Typical High
$12.59
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$181.97
Typical High
$478.63
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$131.83
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$14.13
Median
$14.13
Typical High
$234.42
Geisinger
Setting
Professional
Modifier
None
Typical Low
$4.37
Median
$117.49
Typical High
$199.53
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$10.00
Median
$10.00
Typical High
$19.50
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$6.17
Median
$12.88
Typical High
$14.79
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$12.88
Median
$14.79
Typical High
$14.79
United
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$125.89
Typical High
$134.90

Where Pennsylvania sits

The same service costs 10.0 times more in Oregon than in Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 48th of 51

$12.59

OR $126VA $12.59

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.