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Massachusetts rates for HCPCS Q4248

Dermacyte Amniotic Membrane Allograft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $1,000.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,128.31 / $8,128.31 / $8,128.31
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $234.42 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $199.53 / $295.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,128.31 / $8,128.31 / $8,128.31
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $2,454.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $4,570.88 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $549.54 / $2,818.38