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Maine rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $507.09 / $507.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $487.59
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $507.09 / $507.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$487.59 / $487.59 / $707.01