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
Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.
| Hospital | Medicare Advantage rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $141 – $155 | — | — |
| Deaconess Medical Center | $136 – $149 | — | — |
| Harborview Medical Center | $144 – $159 | — | — |
| Highline Medical Center | — | $27.11 – $3,717 | $88.76 – $12,174 |
| Island Hospital | $149 – $157 | — | — |
| Kadlec Regional Medical Center | $139 – $166 | $406 – $3,275 | $580 – $4,678 |
| Legacy Salmon Creek Medical Center | $143 – $155 | — | — |
| Mary Bridge Children's Hospital | $142 – $157 | — | — |
| MultiCare Auburn Medical Center | $142 – $156 | — | — |
| MultiCare Covington Medical Center | $142 – $156 | — | — |
| MultiCare Good Samaritan Hospital | $142 – $157 | — | — |
| MultiCare Valley Hospital | $140 – $149 | — | — |
| Olympic Medical Center | $156 – $201 | — | — |
| Overlake Hospital Medical Center & Clinics | $145 – $150 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $139 – $166 | $570 – $3,693 | $815 – $5,275 |
| Providence Centralia Hospital | $144 – $231 | $604 – $6,061 | $1,162 – $11,655 |
| Providence Holy Family Hospital | $139 – $153 | $570 – $3,693 | $815 – $5,275 |
| Providence Mount Carmel Hospital | — | $540 – $3,526 | $772 – $5,037 |
| Providence Regional Medical Center Everett | $142 – $156 | $37.46 – $6,128 | $72.04 – $11,785 |
| Providence St Joseph Hospital | — | $540 – $3,526 | $772 – $5,037 |
| Providence St Mary Medical Center | $139 – $153 | $470 – $3,435 | $671 – $4,907 |
| Providence St Peter Hospital | $143 – $229 | $604 – $6,061 | $1,162 – $11,655 |
| St Anthony Hospital | — | $27.00 – $3,703 | $88.76 – $12,174 |
| St Clare Hospital | — | $25.59 – $3,509 | $88.76 – $12,174 |
| St Elizabeth Hospital | $15.98 – $2,678 | $31.37 – $4,302 | $88.76 – $12,174 |
| St Francis Community Hospital | — | $27.86 – $3,820 | $88.76 – $12,174 |
| St Joseph Medical Center | — | $29.40 – $4,032 | $88.76 – $12,174 |
| St Michael Medical Center | — | $39.18 – $5,373 | $88.76 – $12,174 |
| Swedish Edmonds Hospital | $142 – $170 | $414 – $3,568 | $863 – $7,433 |
| Swedish Issaquah | $145 – $173 | $414 – $3,568 | $863 – $7,433 |
| Swedish Medical Center | $144 – $173 | $414 – $3,568 | $863 – $7,433 |
| Swedish Medical Center / Cherry Hill | $144 – $173 | $414 – $3,568 | $863 – $7,433 |
| Tacoma General Allenmore Hospital | $142 – $157 | — | — |
| University of Washington Medical Ctr | $144 – $159 | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $146 – $163 | — | — |
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