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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
$7.87 / $7.87 / $7.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $8.19
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.14 / $9.11 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $32.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.44 / $9.66 / $17.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.02 / $15.74 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
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
$7.87 / $7.87 / $32.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.71 / $7.87 / $13.02