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HCPCS Q4103

Oasis burn matrix, per square centimeter (add-on, list separately in addition to primary procedure)

Current codeSkin Substitute Products36 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Unknown: The source file doesn't say which population this rate applies to.

HospitalUnknown rates (lowest – highest)Cash priceList price (before discounts)
Highline Medical CenterBurienFile dated 2026-02-28—$27.11 – $3,717$88.76 – $12,174
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$406 – $3,275$580 – $4,678
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01—$570 – $3,693$815 – $5,275
Providence Centralia HospitalCentraliaFile dated 2026-04-01—$604 – $6,061$1,162 – $11,655
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$570 – $3,693$815 – $5,275
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01—$540 – $3,526$772 – $5,037
Providence Regional Medical Center EverettEverettFile dated 2026-04-01—$37.46 – $6,128$72.04 – $11,785
Providence St Joseph HospitalChewelahFile dated 2026-04-01—$540 – $3,526$772 – $5,037
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01—$470 – $3,435$671 – $4,907
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$604 – $6,061$1,162 – $11,655
St Anthony HospitalGig HarborFile dated 2026-02-28—$27.00 – $3,703$88.76 – $12,174
St Clare HospitalLakewoodFile dated 2026-02-28—$25.59 – $3,509$88.76 – $12,174
St Elizabeth HospitalEnumclawFile dated 2026-02-28—$31.37 – $4,302$88.76 – $12,174
St Francis Community HospitalFederal WayFile dated 2026-02-28—$27.86 – $3,820$88.76 – $12,174
St Joseph Medical CenterTacomaFile dated 2026-02-28—$29.40 – $4,032$88.76 – $12,174
St Michael Medical CenterSilverdaleFile dated 2026-02-28—$39.18 – $5,373$88.76 – $12,174
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01—$414 – $3,568$863 – $7,433
Swedish IssaquahIssaquahFile dated 2026-04-01—$414 – $3,568$863 – $7,433
Swedish Medical CenterSeattleFile dated 2026-04-01—$414 – $3,568$863 – $7,433
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$414 – $3,568$863 – $7,433

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

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