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Massachusetts rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $14.13
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $7.94 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $125.89 / $134.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $141.25 / $281.84
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
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
$7.94 / $7.94 / $16.98
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.89 / $7.94 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.71 / $125.89 / $134.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.59 / $12.59 / $16.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.59 / $7.94 / $125.89