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Massachusetts rates for HCPCS Q4219

Surgigraft-Dual Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.00 / $1,020.00 / $1,020.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,140.00 / $1,140.00 / $2,400.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $4,560.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$153.38 / $176.60 / $225.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.00 / $1,020.00 / $1,020.00
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
$1,020.00 / $1,020.00 / $1,020.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,140.00 / $1,140.00 / $2,400.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.99 / $788.99 / $4,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.87 / $788.99 / $1,305.02