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Maine rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $101.86 / $101.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.11 / $108.88 / $310.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $107.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $101.86 / $101.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $146.91