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Oasis Burn Matrix

Rhode Island 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 $166 · 10th–90th $126$2570%20%40%10th90th$166Professionalmedian $13 · 10th–90th $13$1260%50%10th90th$13$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$12.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$257.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$125.89
Typical High
$125.89