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Massachusetts rates for HCPCS Q4107

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.90 / $85.96 / $85.96
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $101.13 / $284.79
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.00 / $136.47 / $844.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.08 / $117.97 / $216.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $85.96 / $85.96
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.76 / $101.76 / $119.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.59 / $92.59 / $92.59
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.13 / $101.13 / $202.26
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.47 / $136.47 / $844.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.00 / $136.47 / $204.71