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Maine rates for HCPCS Q4176

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.80 / $161.50 / $161.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.92 / $65.92 / $65.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.92 / $65.92 / $65.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.76 / $167.51 / $242.89