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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 July 2026.

Facilitymedian $16 · 10th–90th $11$3800%10%20%10th90th$16Professionalmedian $14 · 10th–90th $13$1260%50%10th90th$14$5.0$20.0$100.0$500.0

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
$13.80
Median
$13.80
Typical High
$91.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$57.54
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$8.91
Median
$125.89
Typical High
$125.89
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$169.82
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$10.23
Median
$26.92
Typical High
$562.34
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$9.77
Median
$21.88
Typical High
$33.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$33.11
Typical High
$75.86
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$12.59
Typical High
$14.45
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$4.07
Median
$6.03
Typical High
$13.18
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$13.18
Median
$13.18
Typical High
$13.80
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$8.13
Median
$8.91
Typical High
$125.89
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$154.88
Typical High
$295.12