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Massachusetts rates for HCPCS Q4165

Keramatrix Or Kerasorb Per Square Centimeter (Desc Rvsd 10/1/19)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.59 / $45.25 / $45.25
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $106.48 / $818.35
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $202.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.75 / $19.29 / $24.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $106.48
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $202.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $85.61