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Maine rates for HCPCS Q4102

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.36 / $12.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.36 / $12.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $17.23