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Massachusetts rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $251.19
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,148.15
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
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
$181.97 / $181.97 / $213.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $125.89
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,148.15
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $154.88 / $1,148.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $125.89 / $954.99