go back

Maine rates for HCPCS Q4165

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.66 / $45.25 / $45.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.19 / $11.02 / $34.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.25 / $45.25 / $45.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $44.36 / $64.31