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Maine rates for HCPCS Q4156

Neox 100 or Clarix 100, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $128.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $125.89 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $79.43
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $66.07 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $125.89 / $177.83