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Maine rates for HCPCS Q4154

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.16 / $137.16 / $137.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $137.16 / $137.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $142.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.90 / $131.90 / $131.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $131.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $131.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $137.16 / $137.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $131.90 / $191.26