Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HC Oasis Burn Matrix (7 X 20 Cm), per Sq Cm
Gary, IN
See all hospitals reporting HCPCS Q4103 →Price type
The Methodist Hospitals, Inc.’s median price of $59 is 10% below the median hospital's median price ($65), higher than 49% of the 1,183 hospitals reporting HCPCS Q4103. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 22 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Cigna hmo facility · percent of total billed charges · outpatientfrom % of charges | $27 | $27 | — | — | — | $27 – $27 |
| 2 | Cigna ppo facility · percent of total billed charges · outpatientfrom % of charges | $29 | $29 | — | — | — | $29 – $29 |
| 3 | Aetna firsthealth facility · percent of total billed charges · outpatientfrom % of charges | $43 | $43 | — | — | — | $43 – $43 |
| 4 | Phcs ppo facility · percent of total billed charges · outpatientfrom % of charges | $47 | $47 | — | — | — | $47 – $47 |
| 5 | MultiPlan ppo facility · percent of total billed charges · outpatientfrom % of charges | $50 | $50 | — | — | — | $50 – $50 |
| 6 | Anthem indiana hmo medicaid facility · fee schedule · outpatient | $51 | $51 | — | — | — | $51 – $51 |
| 7 | Caresource indiana hmo medicaid facility · fee schedule · outpatient | $51 | $51 | — | — | — | $51 – $51 |
| 8 | Humana indiana hmo medicaid facility · fee schedule · outpatient | $51 | $51 | — | — | — | $51 – $51 |
| 9 | UnitedHealthcare indiana hmo medicaid facility · fee schedule · outpatient | $51 | $51 | — | — | — | $51 – $51 |
| 10 | Aetna coventry facility · percent of total billed charges · outpatientfrom % of charges | $51 | $51 | — | — | — | $51 – $51 |
| 11 | UnitedHealthcare hmo_and_ppo_contracted_plans facility · other · outpatient | $127 | $127 | — | — | — | $127 – $127 |
| 12 | UnitedHealthcare navigate and core payer facility · other · outpatient | $127 | $127 | — | — | — | $127 – $127 |
| 13 | Aetna medicare advantage facility · fee schedule · outpatient | $131 | $131 | — | — | — | $131 – $131 |
| 14 | Anthem medicare advantage facility · fee schedule · outpatient | $131 | $131 | — | — | — | $131 – $131 |
| 15 | Humana medicare advantage facility · fee schedule · outpatient | $131 | $131 | — | — | — | $131 – $131 |
| 16 | Medicare medicare facility · fee schedule · outpatient | $131 | $131 | — | — | — | $131 – $131 |
| 17 | Anthem pathway essentials facility · fee schedule · outpatient | $197 | $197 | — | — | — | $197 – $197 |
| 18 | Caresource caresource facility · fee schedule · outpatient | $216 | $216 | — | — | — | $216 – $216 |
| 19 | Aetna hmo_and_ppo_contracted_plans facility · fee schedule · outpatient | $259 | $259 | — | — | — | $259 – $259 |
| 20 | Ambetter ambetter healthplan facility · fee schedule · outpatient | $262 | $262 | — | — | — | $262 – $262 |
| 21 | Anthem individual on exchange facility · fee schedule · outpatient | $349 | $349 | — | — | — | $349 – $349 |
| 22 | Anthem traditonal,hmo,ppo contracted plans and individual off exchange facility · fee schedule · outpatient | $436 | $436 | — | — | — | $436 – $436 |
Last updated: Aug 18, 2026
See Oasis wound matrix for burns pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.