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Massachusetts rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $91.20
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $134.90 / $380.19
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $125.89 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $234.42 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $213.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $125.89
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $134.90 / $380.19
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $125.89 / $245.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $138.04 / $177.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $125.89