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Maine rates for HCPCS Q4166

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.97 / $20.77 / $20.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.97 / $19.97 / $20.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.97 / $19.97 / $19.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.97 / $19.97 / $19.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.97 / $19.97 / $19.97
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.97 / $20.77 / $20.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.97 / $19.97 / $28.96