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Oasis Burn Matrix

Utah 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?

$126

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $16.60 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$123 to $126
FacilityA hospital or hospital-owned outpatient department$16.60$14.45 to $30.90

How much rates vary

Facilitymedian $17 · 10th to 90th $14 to $151Professionalmedian $126 · 10th to 90th $14 to $145
$20$50$100$200$500facility $17professional $126

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
$14.45
Median
$14.45
Typical High
$14.45
Aetna
Setting
Professional
Modifier
None
Typical Low
$13.80
Median
$14.45
Typical High
$14.45
Cigna
Setting
Facility
Modifier
None
Typical Low
$14.45
Median
$19.05
Typical High
$151.36
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
None
Typical Low
$1.91
Median
$30.20
Typical High
$60.26
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$131.83
Typical High
$151.36
Select Health
Setting
Facility
Modifier
None
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Select Health
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$120.23
Typical High
$154.88
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$162.18
Typical High
$269.15
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Utah 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.

Utah· 12th of 51

$126

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.