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Massachusetts rates for HCPCS Q4103

Oasis Burn Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.99
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.11 / $41.38 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $6,184.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.40 / $15.34 / $28.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.74 / $24.98 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $21.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $6,184.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $20.66