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Maine rates for HCPCS Q4128

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82,796.48 / $82,796.48 / $95,850.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $31.11 / $31.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $30.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82,796.48 / $82,796.48 / $95,850.45
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $31.11 / $31.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $43.37