go back

Massachusetts rates for HCPCS Q4221

Amnio Wrap2, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $2,039.44
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.50 / $2,608.50 / $5,700.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $7,505.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,909.00 / $2,867.00 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,905.97 / $2,905.97 / $3,418.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $1,961.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,608.50 / $2,608.50 / $5,700.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $7,505.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.00 / $1,961.00 / $3,243.57