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Maine rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $13.38 / $13.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $14.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $13.38 / $13.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $19.57