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Maine rates for HCPCS Q4110

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $68.02 / $68.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $65.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.40 / $65.40 / $65.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.40 / $65.40 / $65.40
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $65.41
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $68.02 / $68.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $94.84