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Maine rates for HCPCS Q4101

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.44 / $1,679.11 / $4,157.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $31.44 / $31.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,679.11 / $4,157.85 / $4,185.71
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $31.44 / $31.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $43.83