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Maine rates for HCPCS Q4103

Oasis Burn Matrix

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.99 / $12.99
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.99 / $12.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $18.11