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Massachusetts rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $73.52
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $300.00 / $320.72
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $345.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $106.23 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $300.00 / $320.72
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $345.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $146.12