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Maine rates for HCPCS Q4190

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $141.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $125.89 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $125.89
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $125.89 / $812.83