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Massachusetts rates for HCPCS Q4128

FlexHD, or AllopatchHD, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $31.21
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.41 / $89.28 / $135.06
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $135.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.09 / $36.72 / $67.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.51 / $53.00 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.47 / $35.47 / $41.73
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,684.67 / $12,684.67 / $13,261.25
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $135.06
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $135.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.52 / $29.91 / $56.40