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Maine rates for HCPCS Q4169

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,151.21 / $2,151.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,220.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,068.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,068.46
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,068.46
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,151.21 / $2,151.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,068.46 / $2,068.46 / $2,999.28