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Maine rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $681.51 / $681.51
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $720.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $681.51 / $681.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $982.95