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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 July 2026.

Facilitymedian $13 · 10th–90th $13$4470%50%90th$13Professionalmedian $13 · 10th–90th $13$1260%50%90th$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
$21.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$13.18
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$12.59
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$446.68
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$14.13
Median
$14.13
Typical High
$147.91
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$4.37
Median
$128.82
Typical High
$199.53
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$21.38
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$13.18
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$5.13
Median
$12.88
Typical High
$16.22
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$12.88
Typical High
$14.79
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$125.89
Typical High
$134.90