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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)

Facilitymedian $16 · 10th–90th $2$2240%20%10th90th$16Professionalmedian $3 · 10th–90th $2$1260%20%40%10th90th$3$2.0$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $10.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.24 / $125.89 / $707.95
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.17 / $125.89 / $245.47
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.13 / $14.13 / $28.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $269.15 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $181.97 / $2,951.21
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $181.97 / $257.04
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $2.51 / $4.17
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.24 / $125.89 / $707.95
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.17 / $125.89 / $245.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.12 / $16.22 / $19.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $9.12 / $125.89