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Massachusetts rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $55,573.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $102.85 / $102.85
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.95 / $242.00 / $818.35
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $459.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.34 / $141.16 / $259.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18,957.11 / $18,957.11 / $19,641.40
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.95 / $242.00 / $242.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $459.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $110.00 / $181.94