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Massachusetts rates for HCPCS Q4203

Derma-gide, 1 sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,095.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,400.54 / $1,400.54 / $1,688.59
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $2,642.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.89 / $1,581.97 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,400.54 / $1,400.54 / $1,688.59
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $2,642.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$947.60 / $1,052.89 / $1,741.52