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Vermont rates for HCPCS Q4103

Oasis Burn Matrix

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $12.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $14.18 / $23.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $23.64
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.78 / $14.18 / $23.64
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $23.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.49 / $12.49 / $37.47