HCPCS Q4103
Oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure)
Current codeSkin Substitute Products36 hospitals with prices
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $238 – $644 | — | — |
| Deaconess Medical Center | $229 – $567 | — | — |
| Harborview Medical Center | $231 – $307 | — | — |
| Highline Medical Center | $35.84 – $10,957 | $27.11 – $3,717 | $88.76 – $12,174 |
| Island Hospital | $193 – $267 | — | — |
| Kadlec Regional Medical Center | $15.50 – $390 | $406 – $3,275 | $580 – $4,678 |
| Legacy Salmon Creek Medical Center | $19.67 – $277 | — | — |
| Mary Bridge Children's Hospital | $1,000 | — | — |
| MultiCare Auburn Medical Center | $239 – $597 | — | — |
| MultiCare Covington Medical Center | $239 – $597 | — | — |
| MultiCare Good Samaritan Hospital | $240 – $597 | — | — |
| MultiCare Valley Hospital | $229 – $566 | — | — |
| Olympic Medical Center | — | — | — |
| Overlake Hospital Medical Center & Clinics | $23.21 – $380 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $14.23 – $460 | $570 – $3,693 | $815 – $5,275 |
| Providence Centralia Hospital | $37.44 – $539 | $604 – $6,061 | $1,162 – $11,655 |
| Providence Holy Family Hospital | $14.23 – $508 | $570 – $3,693 | $815 – $5,275 |
| Providence Mount Carmel Hospital | — | $540 – $3,526 | $772 – $5,037 |
| Providence Regional Medical Center Everett | $14.23 – $440 | $37.46 – $6,128 | $72.04 – $11,785 |
| Providence St Joseph Hospital | — | $540 – $3,526 | $772 – $5,037 |
| Providence St Mary Medical Center | $76.43 – $408 | $470 – $3,435 | $671 – $4,907 |
| Providence St Peter Hospital | $23.17 – $559 | $604 – $6,061 | $1,162 – $11,655 |
| St Anthony Hospital | $29.91 – $9,130 | $27.00 – $3,703 | $88.76 – $12,174 |
| St Clare Hospital | $29.91 – $9,130 | $25.59 – $3,509 | $88.76 – $12,174 |
| St Elizabeth Hospital | $29.56 – $10,957 | $31.37 – $4,302 | $88.76 – $12,174 |
| St Francis Community Hospital | $29.91 – $9,130 | $27.86 – $3,820 | $88.76 – $12,174 |
| St Joseph Medical Center | $29.91 – $9,130 | $29.40 – $4,032 | $88.76 – $12,174 |
| St Michael Medical Center | $25.24 – $10,957 | $39.18 – $5,373 | $88.76 – $12,174 |
| Swedish Edmonds Hospital | $14.23 – $510 | $414 – $3,568 | $863 – $7,433 |
| Swedish Issaquah | $14.23 – $613 | $414 – $3,568 | $863 – $7,433 |
| Swedish Medical Center | $14.23 – $611 | $414 – $3,568 | $863 – $7,433 |
| Swedish Medical Center / Cherry Hill | $14.23 – $611 | $414 – $3,568 | $863 – $7,433 |
| Tacoma General Allenmore Hospital | $240 – $597 | — | — |
| University of Washington Medical Ctr | $231 – $452 | — | — |
| Wellfound Behavioral Health Hospital | $367 | — | — |
| Yakima Valley Memorial | $233 – $353 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Doctor's fee, Seattle (King County)
- $156 in an office; $156 in a hospital or surgery center
- Doctor's fee, rest of Washington
- $134 in an office; $134 in a hospital or surgery center
- Hospital outpatient payment (national)
- $127 (APC 6001)
- Surgery center payment (national)
- $127