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Oasis Burn Matrix

South Carolina 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 $16 · 10th–90th $13$1740%20%10th90th$16Professionalmedian $13 · 10th–90th $13$1260%50%10th90th$13$2.0$10.0$50.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$17.38
Typical High
$46.77
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.88
Typical High
$13.49
BCBS
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$13.18
Typical High
$13.18
BCBS
Setting
Professional
Modifier
Global
Typical Low
$14.45
Median
$17.38
Typical High
$144.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$6.76
Median
$13.18
Typical High
$28.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$54.95
Typical High
$87.10
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$125.89