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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
$660.69 / $660.69 / $676.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $660.69 / $1,819.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $660.69 / $1,737.80