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Maine rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $690.17 / $690.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $717.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $690.17 / $690.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $962.26