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Maine rates for HCPCS Q4173

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $362.98 / $362.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $349.02 / $356.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$349.01 / $349.01 / $349.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.01 / $349.01 / $349.01
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $349.02 / $349.02
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $362.98 / $362.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.02 / $349.02 / $523.53