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Massachusetts rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $64.91
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.53 / $191.10 / $262.88
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $288.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.97 / $76.64 / $140.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $93.77 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.49 / $91.49 / $107.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.50 / $97.50 / $262.88
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $288.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $103.23