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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
$10.96 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $10.96 / $16.22
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.55 / $25.70 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $125.89 / $223.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $25.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.75 / $11.75 / $11.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $11.75
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $234.42 / $8,511.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $11.75 / $25.70
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.55 / $25.70 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $125.89 / $223.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $19.95 / $25.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $30.20 / $125.89