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Oasis Burn Matrix

Washington 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 Washington, 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 $151 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 10 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$13.49 to $126
FacilityA hospital or hospital-owned outpatient department$151$12.59 to $234

How much rates vary

Facilitymedian $151 · 10th to 90th $5 to $309Professionalmedian $126 · 10th to 90th $13 to $151
$10$100$1Kfacility $151professional $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
$13.80
Median
$1,905.46
Typical High
$1,905.46
Aetna
Setting
Professional
Modifier
None
Typical Low
$12.59
Median
$13.80
Typical High
$13.80
Asuris Northwest Health
Setting
Facility
Modifier
None
Typical Low
$95.50
Median
$204.17
Typical High
$354.81
Asuris Northwest Health
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$141.25
Typical High
$6,165.95
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$186.21
Typical High
$295.12
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$10.23
Median
$25.12
Typical High
$33.11
Molina
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$141.25
Typical High
$190.55
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$12.30
Median
$12.59
Typical High
$20.89
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$3.98
Median
$5.13
Typical High
$12.59
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$12.88
Median
$12.88
Typical High
$12.88
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$8.13
Median
$8.91
Typical High
$125.89
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$204.17
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$154.88
Typical High
$295.12

Where Washington sits

The same service costs 10.0 times more in Illinois than in Pennsylvania. 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.

Washington· 14th of 51

$126

IL $126PA $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.