go back

Massachusetts rates for HCPCS Q4102

Oasis wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $12.71
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.91 / $25.43 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $1,591.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.75 / $14.59 / $26.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.12 / $23.76 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
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
$11.88 / $11.88 / $1,591.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $19.64