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Massachusetts rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $681.51
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,487.50 / $1,487.50 / $4,487.09
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $4,487.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $984.59 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,487.50 / $1,487.50 / $4,487.09
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $4,487.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,354.37