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Maine rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $10.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $125.89 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $7.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.94 / $7.94 / $9.55
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $25.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.94 / $125.89