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Massachusetts rates for HCPCS Q4196

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $108.34
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.32 / $547.60 / $547.60
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $466.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.03 / $151.80 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $101.03
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.32 / $547.60 / $547.60
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $466.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.03 / $101.03 / $194.99