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Maine rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $48.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $63.10 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $38.90 / $46.77
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $39.81 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $61.66 / $125.89