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Massachusetts rates for HCPCS Q4124

OASIS ultra tri-layer 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
$2.49 / $2.49 / $2.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.59
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.61 / $8.25 / $85.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $5,398.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.67 / $3.06 / $5.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $4.98 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.07 / $13.07 / $15.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $85.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $5,398.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $5.15