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Maine rates for HCPCS Q4153

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $143.44 / $143.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $137.93
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $143.44 / $143.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.93 / $137.93 / $200.00