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Maine rates for HCPCS Q4123

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $74.41 / $74.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $71.55 / $71.55
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.55 / $74.41 / $74.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.19 / $71.55 / $103.75