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Oasis Burn Matrix

Texas 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 $4$3310%20%10th90th$13Professionalmedian $13 · 10th–90th $13$1260%50%90th$13$1.0$5.0$20.0$100.0$500.0$2.0K

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
$12.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$13.49
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.55
Median
$3.89
Typical High
$7.24
Christus
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$120.23
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$302.00
Typical High
$851.14
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$6,165.95
Median
$6,165.95
Typical High
$6,165.95
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$7.08
Median
$12.59
Typical High
$109.65
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$190.55
Typical High
$234.42
Molina
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.30
Typical High
$32.36
Providence
Setting
Facility
Modifier
Global
Typical Low
$10.96
Median
$15.14
Typical High
$199.53
Providence
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$120.23
Typical High
$169.82