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Oasis Burn Matrix

Wisconsin 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 $23 · 10th–90th $12$4900%20%10th90th$23Professionalmedian $13 · 10th–90th $13$2000%50%10th90th$13$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$12.88
Median
$12.88
Typical High
$12.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.88
Typical High
$15.14
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$28.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$30.90
Median
$40.74
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$125.89
Typical High
$223.87
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$27.54
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$15.14
Typical High
$15.85
Medica
Setting
Facility
Modifier
Global
Typical Low
$12.30
Median
$12.88
Typical High
$75.86
Medica
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$12.30
Typical High
$25.70
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$50.12
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$13.18
Median
$13.80
Typical High
$13.80
Network Health
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$13.18
Typical High
$21.38
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$12.59
Median
$12.59
Typical High
$27.54
Quartz
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$229.09
Typical High
$416.87
Quartz
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$707.95
Quartz
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$6,165.95
Security Health
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$16.98
Typical High
$20.89
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54