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Maine rates for HCPCS Q4187

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $257.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $245.47 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $245.47 / $269.15